Academy Human Resources Reading Berkshire UK

Education Details
Title		Full name:
Marital status:		Date of birth:		Nationality:
Permanent address:
Telephone:

Name of School/College		O-Level, GCSE and A-Level Qualifications State subjects and grades		Date






Further Education Details
Name of University/College		Degrees & Post Graduate Qualifications State subjects, grades and class of degree		Date






What category/ies would you be prepared to work?
Nursery		KS4		If you have a preferred category please state
KS1		A Level
KS2		Special Needs
KS3		Home Tuition
Where applicable which subjects do you prefer?

What hours are you looking for?		Part time		Short term bookings
What hours are you looking for?		Full time		Long term bookings
Will Academy be your only employment?		Yes No	If No, will Academy be your main employment?		Yes No
Date available to start:			Are you looking for a permanent position?		Yes No

Are you or have you ever been the subject of a disciplinary procedure?				Yes No
Have you ever been convicted of a criminal offence including 'spent' convictions?				Yes No
By submitting this form I certify that the information given above is true, and if I become the subject of any Professional or Police investigation I will inform Academy immediately.


Health Questionnaire All information is held in confidence
Have you ever suffered from are are you suffering from:
Back related problems		Yes No	Epilepsy		Yes No
Nervous breakdown/mental disorder		Yes No	Eczema		Yes No
Diabetes		Yes No	Heart or circulatory illness		Yes No
Migraine		Yes No	Blood disorders or anaemia		Yes No
Dysmenorrhoea		Yes No	Recurrent attacks of diarrhoea		Yes No
If you answered yes to any of the above please give details


Have you ever had any major accidents or head injuries?		Yes No
If yes, please give details


Have you ever had any major operations or illnesses?		Yes No
If yes, please give details


Do you have or are you the carrier of any communicable diseases?		Yes No
If yes, please give details


Have you been immunised against:
Rubella (German Measles)		Yes No	If yes give date if known
Tuberculosis (BCG)		Yes No	If yes give date if known
Tetanus		Yes No	If yes give date if known
Hepatitis B		Yes No	If yes give date if known
Polio		Yes No	If yes give date if known

Do you have any allergies (e.g. penicillin)		Yes No	If yes please give details

Please give details about your:
Height:		Weight:		Blood group:

Are you currently receiving any medicine or treatment?		Yes No	If yes please give details
Are you a smoker?		Yes No
Are you at this time pregnant?		Yes No
Have you ever been refused employment on health grounds?		Yes No

How many days off sick have you had in the last 12 months?

Please give the name, address and telephone number of your next of kin



Name of current/last employer:
LEA:
Job title:				Salary:
Dates of employment:
Boys, Girls or Mixed?		Group size:		Age range:
Do you have qualified teacher status?		Yes No		Teacher DFEE number:

Full Employment History (State most recent first)
Dates		Employer	Job title, main duties and responsibilities		Salary
From	To	Employer	Job title, main duties and responsibilities		Salary







Please list any vocational training you have undertaken with dates


References
Please give the names and addresses of two people who will provide a reference. At least one should be from your current/last employer, but references from colleges are also acceptable. If you give a home address for a referee, please indicate which employer or college they represent.
Referee 1			Referee 2
Name:			Name:
Address:			Address:
Position held:			Position held:
Telephone number:			Telephone number:


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Reading: 0118 959 0999
Southampton: 02380 672727

Fax: 0118 958 2899

enquiries@academyhr.com

Health Questionnaire