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Registration Form - Boston Rose - 2010

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BOSTON ROSE
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  DNS Ev1 : ©Boston Rose 2009 Temp Desk Contact: Tel 0203 006 5832 Fax 0203 060 3963 Company Number 5015384 Registration Form - Education HQ Ref: To ensure that your application proceeds smoothly, pre-appointment checks can be put in place and to help avoid any delay, please: a) complete all sections of this form in BLACK INK / TYPE and in CAPITALS if hand written b) note that all sections must be completed by the Applicant 1. Personal Details Title: Date of Birth: Surname: Forename(s): HQ Number (Internal Use Only) 2. Disclosure Boston Rose are required by CRB regulations to carry out an Enhanced Disclosure Certificate (“CRB”) issued by the Criminal Records Bureau or Disclosure Scotland. Please select one of the following options  YES NO a) I have submitted a copy of my CRB to Boston Rose which is no more than 12 months  old whilst my new CRB is being processed. I enclose my completed CRB Application Form. b) I do not hold a current CRB, so have enclosed a completed CRB Application Form and I have supplied the necessary srcinal ID documentation to you with the application (Please ensure you complete section 3 of the registration form if you tick this option) Please confirm: YES Legislation provides that the applicant should pay for the CRB check. No mark up is charged by Boston Rose. I enclose a cheque made payable to “Boston Rose” for £46.00 for the CRB fee I consent to Boston Rose passing a CRB relating to me onto interested third parties (such as a College)  *We will not be able to process your CRB until we have received a cheque for the sum above. Prompt payment will avoid any delays of your start date or cancellation of your appointment.* Mr. 01/07/1975HABOOL AL-SHAMERYMAITHAM  DNS Ev1 : ©Boston Rose 2009 Temp Desk Contact: Tel 0203 006 5832 Fax 0203 060 3963 Company Number 5015384 3. Rehabilitation of Offenders Act 1974 (Exceptions) (Amendments) Order 1986 (SI 1986/1249) (“ROA”) Please circle as appropriate Yes / No Have you been convicted of a criminal offence? Yes / No Do you have knowledge of any pending prosecutions in respect of alleged criminal offences (excluding road traffic offences not involving injury to a third party) or a sentence of imprisonment? Please provide details below if you have answered ‘yes’ to either of the above:- Date Offence Sentence Assignments may mean you are involved in teaching or training students under the age of 18, or students with learning difficulties or disabilities. Your registration with Boston Rose and your assignment is therefore classed as “exempt” from the provisions of the ROA. You may be required to apply for an Enhanced Disclosure police check through the Criminal Records Bureau (an executive agency of the Home Office) or if in Scotland, the Scottish Criminal Records Bureau. Consequently you are NOT entitled to withhold information about convictions, which for other purposes are spent under ROA. All information provided by you in the section below will be checked with the relevant authorities.    DNS Ev1 : ©Boston Rose 2009 Temp Desk Contact: Tel 0203 006 5832 Fax 0203 060 3963 Company Number 5015384 4. Referees Please nominate two referees, one of whom must be your latest employer. If you have been working through an agency please provide the contact details for your line manager at your place of work and not details of the agency. Boston Rose will take up both references, so if you have any concerns or timing issues relating to us contacting your referees please indicate so and provide details here: Current / Most Recent Employer Contact before position accepted: Yes / No Name: Company : Position Held: Address: Postcode: Tel No: Fax No: E-mail address: Relationship to Applicant: Previous Employer Name: Company : Position Held: Address: Postcode: Tel No: Fax No: E-mail address: Relationship to Applicant: Education Referee Please complete this section if you have worked in the Education sector previously but they are not your latest employer or previous employer: Company: Contact Name: Contact Position: Contact Tel: Contact E-mail:  Dr David Richardson Faculty of Engineering Design and Mathematics University of the West of England Senior Lecturer Faculty of Engineering Design and Mathematics University of the West of England Frenchay Bristol BS16 1QY0117 328 2223David4.Richardson@uwe.ac.uk  Programme Manager  DNS Ev1 : ©Boston Rose 2009 Temp Desk Contact: Tel 0203 006 5832 Fax 0203 060 3963 Company Number 5015384 5.   Qualifications Please 1.   List all education, professional & trade qualifications that you have been awarded or are currently studying for 2. Supply Original Certificates for all qualifications stated 3. Use the Continuation Sheet (in the Appendix (Section 5)) as necessary SCHOOL QUALIFICATIONS Do you hold a level 2 (GCSE, GCE, CSE Grade 1, Key Skills or equivalent) qualification in: English? Yes [ ] No [ ] Mathematics? Yes [ ] No [ ] QUALIFICATIONS – SCHOOL, FURTHER AND HIGHER EDUCATION, TEACHING  From To Institution FT/PT Qualification Grade/Class PROFESSIONAL or TRADE MEMBERSHIP Are you registered with the IFL (Institute for Learning) or GTC (General Teaching Council)? Please tick as appropriate IFL Yes [ ] No [ ] Membership Number: GTC Yes [ ] No [ ] Membership Number: Main teaching subject taught (if applicable):  

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Jul 23, 2017
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