Registering As A Relieving Teacher

Cotswold School

Registering As A Relieving Teacher
Cotswold School is committed to ensuring the safety and wellbeing, as far as is practicable, of students, employees and visitors both at school and when away from the school on school business.

Our health, safety, and welfare policy enables us to:
- provide a safe physical and emotional environment for students and staff
- meet our legal requirements to ensure the safety of students, employees, and visitors
- promote healthy food and nutrition for all students
Cotswold School has included in its Health, Safety & Welfare Policy the requirements detailed in the Vulnerable Children Act 2014. We are committed to implementing legislation for the vetting and screening of the children’s workforce – these “children’s worker safety checks” became law under the Vulnerable Children Act 2014 (the VCA), and came into force for new workers in core children’s workforce roles on 1 July 2015.

The VCA requires safety checking of all paid employees and contractors, employed or engaged by Cotswold School including Relieving Teachers. The requirements for safety checking also apply to people undertaking unpaid children’s work as part of an educational or vocational training course.

The VCA also contains a restriction on the employment of people with convictions for certain offences in some children’s worker roles, subject to a government-run exemptions process.

More information on the Children’s Action Plan and the Vulnerable Children Act 2014 can be found at: www.childrensactionplan.govt.nz.

If you would like to register for relief teacher work at Cotswold School please complete the details below.

Please bring originals of the documentation you have identified under “Category A Identification Document” and “Category B Identification Document” along with your Practising Certificate (Education Council/Teachers Council Registration Card). Office staff will copy these documents and certify them as copies of the original. These will be held in your employee file.

Chris Smith
Principal

This Application Form has nine sections. You will require the following information when completing this form:

Section 1: Personal details including address and contact details.

Section 2: Proof of Identity.

Section 2A: Identity Referee (Only Visible if Category A or Category B Documentation does not include a photo of you).

Section 3: Whether you are registered as a teacher in New Zealand, your registration category and number and your registration expiry date.

Section 4: Previous paid employment experience including the name of each previous employer, the date you began and ceased your employment with each employer and details of any leadership positions you have held.

Section 5: The names and contact details (address, home phone, work phone, mobile phone and email) for two (2) referees who have direct knowledge of your capabilities. Please ensure the people you list have consented to act as a referee.

Section 6: If you have been convicted of any offences against the law you will need to provide details of the offence.

Section 7: Availability and Year Levels - please outline when you are available to relief teach and the levels you would like to teach

Section 8: An opportunity to attach any Additional Relevant Information

Section 9: Declaration and submission of your application.

SECTION 1 - PERSONAL DETAILS
Name*

PrefixFirst NameMiddle NameLast Name
Are You Know By of Have You Used Any Other Names?:*

YesNo
Please provide details of any other names you are known by or you have used.*
Gender:*

MaleFemale
Date of Birth:*

DayMonthYear
Nationality:*
Place of Birth:*
Address*

Street Address

Street Address Line 2

CityState / Province

Post CodeCountry
Phone Number (Home)*

Area CodePhone Number
Phone Number (Mobile)*

Area CodePhone Number
Other Number

Area CodePhone Number
E-mail*

Confirmation Email
Payroll Number

SECTION 2 - PROOF OF IDENTITY
The Vulnerable Children Action 2014 require safety checking of all paid employees and contractors employed or engaged by Cotswold School. Part of this process is collecting copies of original documents, current and not expired to verify you are the person detailed on this form.

Please tick the two forms of identification below (one from Category A and one from Category B) that you will be providing for us. Please bring the original documents to the Cotswold School office so a copy can be made and verified by the Principal. This needs to happen prior to you working at Cotswold School.
Category A Document Name*
Category B Document Name
Category A Document Number
Category B Document Number
Category A Issue Date (if applicable)

DayMonthYear
Category B Issue Date (if applicable)

DayMonthYear
Category A Expiry Date (if applicable)

DayMonthYear
Category B Expiry Date (if applicable)

DayMonthYear
Does either your Category A or Category B document choice include a photo of you?*

YesNo

SECTION 2A - IDENTITY REFEREE
If one of the documents you provide for us under Category A or Category B does not include a photo of you, either:
1. Provide a photograph of yourself authenticted by an identity referee. The identity referee needs to write on the back of the photograph "Certified true likeness of [your full name] and sign and date the certification; OR
2. A verification statement signed and dated by the identify referee verifying that the Category A identity document relates to you.
Please provide details of your Identity Referee below. Your Identity Referee
- Must have known you for at least 12 months
- Must be at least 16 years of age
- Shoud not be related to you and is not part of your extended family
- Must not be your spouse
- Must not live at the same address as you
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Post CodeCountry
E-mail*

Confirmation Email
Phone Number (Work)*

Area CodePhone Number
Phone Number (Home)*

Area CodePhone Number
Phone Number (Mobile)

Area CodePhone Number
The Identity Referee provided by you:*

Has known you for at least 12 monthsIs at least 16 years of ageIs not related to you and is not part of your extended familyIs not your spouseDoes not live at the same address as you

SECTION 3 - TEACHER REGISTRATION
Teacher Registration Category*

Fully Registered TeacherProvisionally Registered TeacherSubject to ConfirmationApplying For Registration
Registration Number
Expiry Date

DayMonthYear

SECTION 4 - WORK HISTORY
Please provide Work History details covering the last five years starting with your most recent paid employment position.
Please attached your employment history here or complete details below

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Position 1*
Employer 1*
Date Begun 1*
Date Ceased 1
Position 2
Employer 2
Date Begun 2
Date Ceased 2
Position 3
Employer 3
Date Begun 3
Date Ceased 3
Position 4
Employer 4
Date Begun 4
Date Ceased 4
Position 5
Employer 5
Date Begun 5
Date Ceased 5
Position 6
Employer 6
Date Begun 6
Date Ceased 6

SECTION 5 - REFEREES
Two (2) referees who have direct knowledge of your capabilities are required. Please ensure the people you list have consented to act as a referee.
Referee 1:
R1: Full Name*

First NameLast Name
R1: Address*

Street Address

Street Address Line 2

CityState / Province

Post CodeCountry
R1: E-mail*

Confirmation Email
R1: Phone No (Home)*

Area CodePhone Number
R1: Phone No (Work)

Area CodePhone Number
R1: Phone No (Mobile)

Area CodePhone Number
Referee 2:
R2: Full Name*

First NameLast Name
R2: Address*

Street Address

Street Address Line 2

CityState / Province

Post CodeCountry
R2: E-mail*

Confirmation Email
R2: Phone No (Home)*

Area CodePhone Number
R2: Phone No (Work)

Area CodePhone Number
R2: Phone No (Mobile)

Area CodePhone Number

SECTION 6 - OFFENCES AGAINST THE LAW
Have you ever been convicted of any offence against the law apart from summary offences?*

YesNo
Have you ever received a Police Diversion for an offence?*

YesNo
Are you awaiting sentencing/currently have charges pending? *

YesNo
If you answered "Yes" to any of the questions in this section, please provide a digital copy of the date and details of the offence, or other reasons,, together with any comments you may wish to make.

Please note: You may be asked to provide a copy of the relevant Court record(s) obtainable from the Registrar of the Court concerned. Failure to provide correct and true details of any conviction will make you liable to dismissal from employment of the Cotswold School Board of Trustees, should you be the successful applicant.

NB: Under the Vulnerable Children’s Act 2014 core workers will not be covered by the Clean Slate Act 2004.
Please attach any details of conviction/offences here.

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SECTION 8 - ADDITIONAL RELEVANT INFORMATION
Please attach any supporting documentation below. You can attach multiple files.

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SECTION 9 - DECLARATION & SUBMISSION OF APPLICATION
I declare that the information I have supplied is given voluntarily and is true, accurate, and complete in all respects. I acknowledge that I will not hold Cotswold School or the Board of Trustees responsible for any omission or mis- statements that I have made in the information provided.I understand that all information provided about me to you, including my application form, curriculum vitae, references and any assessments will be held by the Cotswold School Board of Trustees to be used for the purposes of evaluating my qualifications, experience and suitability for employment at Cotswold School.I understand that if I withhold relevant information or supply false or misleading information about me, my application may not be further considered. I also understand that my employment may be terminated if, after investigation, my employer discovers that any information which I have provided is false or misleading.I understand that I am entitled to have access to relevant information retained by the Cotswold School Board of Trustees (except for any exemption provided under the Privacy Act 1993 such as evaluative material) and to request correction of the information and/or request that there be attached to the information a statement relating to the fact that I have requested a correction.I consent to the Principal and/or Appointment Committee personnel making enquiries with such organisations including but not limited to inquiries with all former employers, Education Council, and other bodies or organisations which might hold information relevant to my employment, my suitability to manage and any other information that my prospective employer deems necessary to obtain.I acknowledge that this application is covered by all other relevant requirements of the Privacy Act, 1993.
Signature

Clear
Date:*

DayMonthYear
Should be Empty:

Cotswold School

Referee 1:

Referee 2: