Form

PERSONAL DETAILS
APPLICATION FORM

General Expression of Interest (all schools)
Surname*
Given Names*
Title*

Mr Mrs Ms Dr Prof
Former Name (If Applicable)
Marital Status (optional)
Date of Birth (optional)
Day Month Year
Religious Denomination*
Regular practice*

Yes No
Which church/parish are you currently involved with?*
Citizenship
Australian Citizen*

Yes No
Permanent Resident*

Yes No
457 Business VISA*

Yes No
Other (please give details)

Residential Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Correspondence Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Private Phone Number*
Work Phone Number
Mobile Phone Number
Email Address*
Current Position*
Teacher registration/accreditation
INSW Reg. No.
INSW Reg. Level
ISTAA accreditation level
PERSONAL EDUCATIONAL BACKGROUND

Tertiary Education

	Degree/Diploma/Certificate Gained	Years Undertaken	Years Awarded	Name of Institution

EMPLOYMENT

Please commence with the most recent position

	From Date	To Date	Name and Address of Employment	Position Held	Reasons for Leaving

TEACHING PREFERENCE
Please list the position(s) you would be most interested in working in:
Please list the types of schools (inc. locations) you would be interested in working at:
I would like to work

Full-time Casual Coach
OTHER PARTICULARS
List any professional associations of which you are a member, and, where relevant, positions of leadership/responsibility you hold/have held
Outline your interests (e.g. sporting, religious, cultural) and your involvement in any community or other organisations
Please list any other information you want the panel to know in regard to your general background - family, community involvement, special interests, things you have been recognised for, etc.
REFEREES
Referee 1 (Professional)
Name
Occupation
Work Address
Email Address
Contact Phone Number
Referee 2 (Professional)
Name
Occupation
Work Address
Email Address
Contact Phone Number
Occupation
Referee 3 (Personal/Church)
Name
Work Address
Email Address
Contact Phone Number
CURRICULUM VITAE
Please upload your CV in a document format. Note: Must be less than 10MB*
DECLARATION
What is your general state of health?*
Have you ever been convicted of a criminal offence?*

Yes No
If yes, please provide details
Have you ever had any allegations of misconduct made against you?*

Yes No
If yes, please provide details
Do you have you any criminal charges pending?*

Yes No
If yes, please provide details
Have you ever been declared bankrupt in Australia or any other country or do you have current or outstanding proceedings against you that may result in your being declared bankrupt?*

Yes No
If yes, please provide details
Do you have any objection to the employer carrying out appropriate checks?*

Yes No
If yes, please provide details
Should be Empty:

PERSONAL DETAILS

APPLICATION FORM

Citizenship

Teacher registration/accreditation

PERSONAL EDUCATIONAL BACKGROUND

EMPLOYMENT

TEACHING PREFERENCE

OTHER PARTICULARS

REFEREES

Referee 1 (Professional)

Referee 2 (Professional)

Referee 3 (Personal/Church)

CURRICULUM VITAE

DECLARATION