First Name(s):
Surname:
Street Name and Number:
Suburb (if applicable):
Town/City:
My postal address is the same as my residential address.
Postal Address Street Name and Number:
Home Phone:
Mobile Phone:
Email Address:
Date of Birth (Day/Month/Year eg: 01/11/1970):
Teacher Registration Number:
Category (eg Full):
Expiry Date (Day/Month/Year eg: 01/11/1970):
Carlton School conducts police vetting electronically. Please confirm clicking Agreed below, that you do not have any criminal convictions, or any pending court proceedings that are likely to result in a conviction. (Excludes minor traffic convictions.)
What is your MOE number (This is not your teacher number):
Are you a New Zealand Citizen? Yes No
If not, do you have New Zealand residency (Proof will be required if you get shortlisted)? Yes No
If not, do you have a valid work permit (Proof will be required if you get shortlisted? Yes No
Please list your qualifications:
Where were they obtained?
Current Employement
Position Title:
School Name:
School Address (Street Name and Number):
School Address (Suburb):
School Address (Town/City):
School Phone Number:
Date Appointed (Day/Month/Year eg: 01/11/1970):
Previous Employement
Timeframe:
Do you hold a full drivers licence? Yes No
Drivers Licence Number:
Do you have any health related conditions that could impact on your ability to do the job or that we need to consider in order to provide a safe environment for you to work in? Yes No
If so, please provide details:
EEO Data The purpose of this section is to enable us to collect statistical data to ensure the representation of gender, race, age and disabilities in the workforce. Please complete the sections below:
Your Full Name:
Gender: Male Female
Ethnic Origin:
Any Physical Disability?
Privacy Act Declaration This application is submitted on the understanding that any information provided is for the use of the employer and their authorised representatives who may, at any time have access to this information.
I agree to the Appointment Panel (or its agents).
Accuracy of Information I certify that I am a registered New Zealand Teacher. I give permission for the appointment panel to access my file held by the Teacher’s Council.
I solemnly and sincerely declare that the information I provided here.
List personal qualities, work experience and personal goals that will improve the school.
Your Response:
Your Extra-Curricular activities:
Your Personal Statement:
Leadership - Your strategies for behaviour management:
ICT - Please tell us your skill level in ICT:
Sports - Which sports are you able to coach?
Habits of Mind - Do you have any insight, if so please describe:
Your Professionalism:
Any other relevent information?