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Assessment Only Route

Please fill out the below form. If you have any problems with this, please contact Sean Bates.

Assessment Only application

To apply for our Assessment Only course complete the following form:


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Further Details


Overseas studentHome/EU student


SchoolSelf


YesNo

Qualifications

Please provide a list of your GCSE/O Level qualifications. Include the grade and the year the qualification was gained.

Please provide a list of your A/AS Level qualifications. Include the grade and the year the qualification was gained.


YesNo
Equivalence tests to be booked with www.equivalencytesting.com.

Please provide details of any degree level qualifications including the subject, university, grade, course elements and the dates you attended the course.

Please give details of any other qualifications you have gained including the title, main subject, awarding body and period of study.

Please provide information on whether you have completed & passed your QTS Skill's Test's in Literacy & Numeracy.


Beginning with your current or most recent employment please provide your post title, employer's name, and address and dates you held the position. This must include experience of two school settings and teaching in two consecutive age ranges.


Please provide details of and dates of any other relevant experience or achievements.


Please explain why you wish to join the teaching profession and specifically why you wish to teach your chosen subject. Include your suitability for the Assessment Only Route.

Rehabilitation of offenders act 1974 (exceptions) order 1975
IMPORTANT NOTE FOR ALL PERSONS APPLYING FOR POSITIONS IN SCHOOLS AND COLLEGES, AND OTHERS WHO WILL WORK WITH YOUNG PERSONS UNDER AGE 18.
The Rehabilitation of Offenders Act 1974 (exceptions) Order 1975 does not allow employees with access to children and young persons under the age of 18 years the right to withhold information regarding previous criminal convictions, including cautions, for any offence (not just those involving children) which for other purposes are ‘spent’ under the provisions of the Act. You should disclose in this section any previous convictions. Any information given, either when returning this application form or at interview will be entirely confidential and will be considered only in relation to this application. Failure to disclose any previous convictions could result in dismissal from the course should it be subsequently discovered. Police checks from Spring 2002 will be replaced by enhanced arrangements through the Criminal Records Bureau. If the checks reveal any undisclosed convictions the Titan Executive Committee reserve the right to withdraw the offer of a place on the course.


Yes, I have a conviction, caution or bind- overNo, I have no convictions, cautions or bind- overs


I declare that I am not on List 99 or disqualified from working with childrenI declare that I have not been accused of a criminal offence, where the case is still ongoing
If yes, please give details on a separate sheet and put it in a sealed envelope marked ‘Confidential’ and send it to Titan or upload below.

Data Protection Act
The information collected in the form will be used in compliance with the Data Protection Act 1998. The information is being collected by Titan Partnership Ltd for the purpose of administering the enrolment and training of trainee teachers. The information may be disclosed, as appropriate, within the Education Service, to school governors, to Occupational Health, to the General Teaching Council, to the Training and Development Agency, and to relevant statutory bodies. You should also note that because we have a duty to protect the public funds we handle, we might need to use the information you have provided on this form to prevent and detect fraud. We may also share this information for the same purposes with other organisations, which handle public funds.

Referees

Please give details of two referees - one academic and one recent character reference.

Referee 2


Please attach a statement from a senior member of staff at your supporting school stating your suitability for the assessment only route.

Declaration

I hereby certify that all the information given on this form is correct to the best of my knowledge and that all the questions related to me have been accurately and fully answered, and that I am in possession of the certificates I claim to hold. I understand that should the information given in this application be incorrect it may render my application invalid.


YesNo

Recruitment monitoring

Please note that the information obtained in this section will not be used as part of the selection process.


11 - White British12 - White Irish19 - Other White Background21 - Black or Black British Caribbean22 - Black or Black British African29 - Other Black Background31 - Asian or Asian British Indian32 - Asian or Asian British Pakistani33 - Asian or Asian British Bangladeshi34 - Chinese39 - Other Asian Background41 - Mixed White and Black Caribbean42 - Mixed White and Back African43 - Mixed White and Asian49 - Other Mixed Background80 - Other

Monitoring - Medical Information

If a place is offered to you, it would be conditional upon your completing a medical questionnaire. Medical questionnaires will be assessed by an independent medical advisor. You may be required to undertake a medical examination as a result of the questionnaire.


YesNo
e.g. dyslexia, partially sighted


YesNo
e.g. diabetes, arthritis


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