Application for Appointment

Send applications to: The Principal Envelopes should be endorsed

Nelson Central School “Confidential Application”
70 Nile Street Curriculum Vitae should be
NELSON accompanied by a self-
addressed stamped envelope
of sufficient size to enable your
documents to be enclosed.
CV of successful applicant will
be kept on file in the school.

Position applied for: Bi-lingual (Maori) Permanent 1 MU (with extra unit(s)

for additional relevant responsibilities
Personal details:

Name: ____________________________________________

Address: ___________________________________________________________________

___________________________________________________________________

Contact phone number: Home ( ) _______________________

Work ( ) ________________________

Present appointment: ________________________________________________________

School: ___________________________________________________________________

Position held: ___________________________________________________________

Names, addresses and phone numbers of three referees, at least one of whom should be
your current or past senior manager or principal and can comment knowledgeably on your
performance as a teacher. In lieu of this reference, Beginning Teachers should supply copies
of reports from Associate Teachers on teaching practices.

Name: ___________________________________________________________________

Address: ___________________________________________________________________

Phone No: Home: ( ) _________________ Work: ( ) _______________________

Capacity you have known the person:____________________________________________

Name: ___________________________________________________________________

Address: ___________________________________________________________________

Phone No: Home: ( ) _________________ Work: ( ) _______________________

Capacity in which you have known the person:_____________________________________

Name: ___________________________________________________________________

Address: ___________________________________________________________________

Phone No: Home: ( ) _________________ Work: ( ) _______________________

Capacity you have known the person:____________________________________________

Education Qualifications: Date Awarded

_________________________________________ ______________

_________________________________________ ______________

_________________________________________ ______________

_________________________________________ ______________

Registration Details: (Please circle)

Full Provisional Expiry date __________

Registration number: ___________________________

Teaching Service

School Class Scale From Until

_________________________________ ____ _____ _____ ____

_________________________________ ____ _____ _____ ____

_________________________________ ____ _____ _____ ____

_________________________________ ____ _____ _____ ____

_________________________________ ____ _____ _____ ____

(Please continue on a separate sheet if necessary.)

Declaration:

Have you ever been convicted of an offence against the law apart from summary offences?

No Yes (If yes, please provide date and details on a separate sheet)

I give permission for any records the police may hold on me to be given to the Board of Trustees as
part of the application process.

I certify I am registered as a New Zealand Teacher and have a current practising certificate.

Do you have an existing condition that would prejudice the execution of your duties? (If yes, please
provide date and details on a separate sheet)

I declare that to the best of my knowledge the information given in this application and my C.V. is true
and correct.

Applicant’s signature: ___________________________________________ Date: _____________

(For office use only) Date application received: _________________________

Please complete for statistical purposes:

Ethnicity: __________________________ Gender: ________

Age: <30 31-40 41-50 51-60 61+ (please circle appropriate)