Form

APPLICATION FORM

For the position of Head of Tudor House School
PERSONAL DETAILS
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

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

Current/Recent Professional Development/Research Undertaken

	Activity	Duration	Year Undertaken	Provider (Name of Institution, Supervisor)

EMPLOYMENT BACKGROUND - CURRENT
Employer*
Business Address*
Current Position*
Date of Appointment*
Day Month Year
Date of Contract End
Day Month Year
Notice Required*
Employer Contact Person*
Contact Number*

Other position(s) held in current employment

	Position	Duration	Responsibility

Current Remuneration package (include all components)*
Latest Professional Review (if available)
PAST EMPLOYMENT

Please commence with the most recent position

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

PROFESSIONAL EXPERIENCE

....

	Responsibility	Employer	Years

PROFESSIONAL VISION AND PHILOSOPHY
Please provide a brief statement of your professional vision and philosophy for the role of Head of Tudor House School.*
SELECTION CRITERIA
Please provide a brief response to the selection criteria.*
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*
Referee 3 (Personal/Church)
Name*
Occupation*
Work Address*
Email Address*
Contact Phone Number*
Contact Permission*

I allow Pathways International Consulting Pty Ltd to contact the named referees solely for the purpose of ascertaining eligibility for employment. Referees will not be contacted without your prior knowledge.
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
Have you previously applied for a position or worked at Tudor House School?*

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

APPLICATION FORM

PERSONAL DETAILS

Citizenship

Teacher registration/accreditation

PERSONAL EDUCATIONAL BACKGROUND

EMPLOYMENT BACKGROUND - CURRENT

PAST EMPLOYMENT

PROFESSIONAL EXPERIENCE

PROFESSIONAL VISION AND PHILOSOPHY

SELECTION CRITERIA

OTHER PARTICULARS

REFEREES

Referee 1 (Professional)

Referee 2 (Professional)

Referee 3 (Personal/Church)

CURRICULUM VITAE

DECLARATION