APPLICATION FORM – TEACHING POSITION

APPLICATION FORM – TEACHING POSITION

Please write or type in the fields below and email your completed form to principal@rghs.school.nz.You may also post your completed form to the school.
Position and Tenure
Title of Position Applied For: e.g. Teacher of English*
Tenure of Position Applied For: e.g. Full-time, Fixed Term for 2023*
Teaching Council of Aotearoa New Zealand (EDUCANZ) – Teacher Registration
EDUCANZ Registration Number:*
EDUCANZ Practising Certificate Expiry Date:*
Personal Details
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
If you have taught under a different name, please state here:
Personal Statement
If you wish, please write or type a brief Personal Statement in below:
Qualifications
Please outline qualifications held. Please provide more details in attached documents if you wish. *
NOTE: Please Provide certified copies of your relevant qualifications with this application.
Teaching Subjects
Please state your main teaching subjects, and the level to which you can teach these subjects.*
Current Position and Responsibilities Held
Please provide more details in attached documents if you wish.*
Details of Previous Teaching Experience
Please list all your previous teaching positions over (at least) the last five years together with the dates of employment.
Details of Previous Non-Teaching Employment

If applicable
Please list all your previous non-teaching positions together with dates of employment.
Extra-curricular Activities
Please list all your previous non-teaching positions together with dates of employment.
Referees

Please indicate the names, positions, addresses and contact telephone numbers of THREE referees. At least one referee must be your current or immediate prior manager or supervisor:
Referee ONE
Name:*
Organisation and Position:*
Telephone:*
Email Address:*
Referee TWO
Name:*
Organisation and Position:*
Telephone:*
Email Address:*
Referee THREE
Name:*
Organisation and Position:*
Telephone:*
Email Address:*
Information on Identity Checking

Please note, in order to meet the requirements of section 31 of theVulnerable Children Act 2014, Rotorua Girls High School will complete a safety check on all appointees. This will include the requirement for all appointees to produce, in person, an original primary identification document (such as valid passport) and a secondary identification document (such as a driver's licence) prior to commencing employment. One of these documents must be photographic. Information on identity confirmation appears on the last page of this application form.
Agreement to Obtain Information

I agree to the references and referees provided to the Rotorua Girls High School Principal, in respect of my application for this position being used for the purposes of considering my suitability for the position for which I am applying. I consent to the Principal of Rotorua Girls High School seeking further verbal or written information on a confidential basis about me from representatives of my present employer, previous employers and referees and authorise the information sought to be released to the school for the purposes of ascertaining my suitability for the position for which I am applying.I understand that the information received by the Principal is supplied in confidence as evaluative material and will not be disclosed to me.
Applicants Signature:*

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Date*

MonthDayYear
Date
Health Declarations
Do you have any existing injuries, medical conditions or health issues that would be aggravated by your performance of the duties and responsibilities outlined in the current job description for the position for which you are applying? E.g. asthma, occupational overuse syndrome, high blood pressure, back injury.*

YESNO
Do you have any existing injuries, medical conditions or health issues which would impede your ability to successfully undertake the duties and responsibilities outlined in the current job description for the position for which you are applying performing the duties of the position applied for?*

YESNO
If you answered either of the above questions in the affirmative, please give details of any existing injuries, medical conditions or health issues and any ACC claims which may affect your performances in the position applied for in the box below: How many days absence have you claimed due to sickness in your last 12 months of employment?
DECLARATION

I declare that I understand any false information given in relation to my medical history may result in my loss of entitlement for any compensation from Accident Compensation Corporation orRotorua Girls High School’s workplace accident insurer, and will make me liable to dismissal from the employment of Rotorua Girls High School should you be the successful applicant.
Applicants Signature: *

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Date*

MonthDayYear
Date
Declaration of Disciplinary Action and / or Convictions
Have you ever been subject to disciplinary action in any previous employment:*

YESNO
If you answered the above question in the affirmative, please provide details together with any comments you may wish to make in the box below:
Have you ever been convicted of any offence(s) against the law (excluding minor traffic convictions) or otherwise know of any reason why you should not be employed to work in this school:*

YESNO
If you answered either of the above questions in the affirmative, please provide the date and details of the offence(s) together with any comment you may wish to make in the box below, except in those cases where your declaration of offence(s) would breach the Criminal Records (Clean Slate) Act 2004:
Information on the Criminal Records (Clean Slate) Act 2004 is attached to this application form.
Are you currently awaiting the hearing of any charges?

YESNO
If you answered the above question in the affirmative, please provide the details of the charge(s) together with any comments you may wish to make in the box below:
The Principal reserves the right to contact the appropriate authorities to verify any claim made.You may be asked to provide a copy of the relevant Court record(s) obtainable from the Police
DECLARATION

I understand that failure to provide correct and true details of any conviction(s) or reason forpossible unsuitability will make me liable to dismissal from the employment of Rotorua Girls HighSchool should you be the successful applicant.
Applicants Signature: *

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Date*

MonthDayYear
Date
Declaration of Relevant Relationships
Are you related to any Rotorua Girls High School employee?*

YESNO
If you answered the above question in the affirmative, please provide the details in the box below
DECLARATION

I declare that to the best of my knowledge the answers provided in this application form and theinformation provided in my Curriculum Vitae and any accompanying documentation are correct.I understand that if any false or misleading information is given, or any material informationsuppressed, I will not be employed, or if I am employed, my employment will be terminated.
Name*

First NameLast Name
Date*

MonthDayYear
Date
Applicants Signature: *

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Attach CV and any other relevant documents here.

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INFORMATION ON THE CRIMINAL RECORDS (CLEAN SLATE) ACT 2004
The Criminal Records (Clean Slate) Act 2004 introduced a clean slate scheme. Under the Act, an individual is legally deemed to have no criminal record and he or she need not disclose convictions if all of the following criteria are satisfied, except as provided in section 31(3) ofthe Vulnerable Children Act 2014.

CRITERIA
1. The individual has not committed any offence within seven consecutive years of being sentenced for the offence, and
2. The individual did not serve a custodial sentence* for the offence (this would exclude serious offences such as murder, manslaughter, rape and causing serious bodily harm), and
3. The offence was not a specified offence (specified offences are in the main sexual in nature), and
4. The individual has paid any fine or costs in full.

* Custodial sentences include a sentence of preventative detention and corrective training. Non-custodial sentencesincludefines,reparation orders, community-based sentences and suspended sentences.

EFFECT OF THIS LEGISLATION
The effect ofthislegislation is that an individual who fulfils all ofthe above criteria can state that he or she has no criminal record in response to questions. If an individual only fulfils some of the criteria he or she is not eligible under the scheme.

EXAMPLES
Person A was convicted of an assault ten years ago and received a community-based sentence. Person A has not committed any offence since that time. Person A is eligible under the scheme.

Person B was convicted oftheft three years ago and received a fine which was paid. Person B is not eligible under the scheme as seven years have not lapsed since the date of conviction.

POLICE VETTING
Printoutsfrom the police computer will notreveal an individual's criminal record if all of the above criteria are fulfilled.
INFORMATION ON THE VULNERABLE CHILDREN ACT 2014
The Vulnerable Children Act 2014 introduced legislative requirements for safety checks pnor to appointment. For your information, section 31 of the Act appears below:

SECTION 31: REQUIREMENT FOR SAFETY CHECKS
(I) Every safety check of a person must comply with the requirements forsafety checks for core workers or for non-core workers (as appropriate) prescribed by this section and by regulations made under section 32.

(2) Every safety check of a person mustinclude-
(a) confirmation of the identity of the person, carried out as prescribed by regulations made under section 32; and
(b) consideration of specific·information prescribed by regulations made under section 32; and
(c) a risk assessment, carried out as prescribed by regulations made under section 32, that assesses the risk the person would pose to the safety of children if employed or engaged as a children's
worker.

(3) Despite anything in the Criminal Records (Clean Slate) Act 2004, nothing in that Act authorises the concealment of a conviction for a specified offence of a person who is subject to a safety check in relation to employment or engagement as a core worker, even if the person is otherwise deemed to have no criminal record.
INFORMATION ON THE VULNERABLE CHILDREN (REQUIREMENTSFOR SAFETY CHECKS OF CHILDREN'S WORKERS) REGULATIONS 2015
For your information, part 5 of the regulations on identity confirmation appears below:

PART 5: IDENTITY CONFIRMATION

(1) A specified organisation must require a person in respect of whom a safety check is being undertaken under this
Part to confirm his or her identity by-
(a) using an electronic identity credential within the meaning of section 8 of the Electronic Identity Verification Act 2012; or
(b) producing the original of -
(i) a primary identity document; and
(ii) a secondary identity document.

(2) If neither of the documents produced by a person under sub-clause (I )(b) contains a photograph of the person, the specified organisation must require the person to -
(a) produce with those documents-
(i) a photograph of himself or herself authenticated by an identity referee; or
(ii) a verification statement signed and dated by an identity referee that verifies that the primary identity document produced by the person relates to that person; and

(b) provide the name and contact details of the identity referee.
(3) If a person's name is different from the person's name on a document produced under sub-clause (I )(b)(i) or (ii), the specified organisation must require the person to produce together with that document a supporting name change document as evidence of the person's name change.
(4) After a person has produced the documents required by sub-clauses (I) to (3), the specified organisation must cause asearch to be made ofitspersonnel records to ascetiain whether theidentity confirmed by the person -
(a) is being used by any other person employed or engaged, or proposed to be employed or engaged, by the organisation; or
(b) has been used by any other person employed or engaged by the organisation.
Should be Empty:

APPLICATION FORM – TEACHING POSITION

Position and Tenure

Teaching Council of Aotearoa New Zealand (EDUCANZ) – Teacher Registration

Personal Details

Personal Statement

Qualifications

Teaching Subjects

Current Position and Responsibilities Held

Details of Previous Teaching Experience

Details of Previous Non-Teaching Employment

Extra-curricular Activities

Referees

Referee ONE

Referee TWO

Referee THREE

Information on Identity Checking

Agreement to Obtain Information

Health Declarations

DECLARATION

Declaration of Disciplinary Action and / or Convictions

DECLARATION

Declaration of Relevant Relationships

DECLARATION

INFORMATION ON THE CRIMINAL RECORDS (CLEAN SLATE) ACT 2004

INFORMATION ON THE VULNERABLE CHILDREN ACT 2014

INFORMATION ON THE VULNERABLE CHILDREN (REQUIREMENTSFOR SAFETY CHECKS OF CHILDREN'S WORKERS) REGULATIONS 2015