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Personal Information  \nFull Name:      \nSurname First Name(s)  \nMr Mrs Ms Miss (Please Circle)  \nAddress:  \n____________________________________________________________  \n_____________________________________________________________  \n_____________________________________________________________  \nTelephone      \nPrivate Mobile  \nFax Email  \nB. Educational Qualifications  \nCertificate: TTC / Dip Tch / H Dip Tch / Special:    \nDate of Certification:    \nTeacher Registration No:   Expiry Date:    \nDegrees / Diplomas: Year  \n_________________________ ___________  \n_________________________ ___________  \nOther Qualifications:  \n______________________________________________  \n______________________________________________  \nTamaki Coll. Application Employment Form Page 1  \nC Current Employment  \nPosition:   Appointed:    \nYear  \nSchool:  \n________________________________  \nLocation:    \nFor the purposes of compliance with the Privacy Act 1993, do you consent to the school contacting your present employer for the purposes of reference checking?  \nYes 􀀡 No 􀀡  \nD. Health  \nDo you have any know condition that may affect your ability to efficiently carry out the functions and responsibilities of the position applied for?  \nYes 􀀡 No 􀀡  \nIf YES, please specify:   This school has a no smoking policy – are you prepared to abide by this?  \nYes 􀀡 No 􀀡  \n\n| E. Convictions Against the Law\u003Cbr>Have you ever been convicted of any criminal offence (other than a minor traffic offence)?\u003Cbr>Yes 􀀡 No 􀀡\u003Cbr>If YES, please list criminal convictions, except in those cases where our asking you to declare them would breach the Criminal Records (Clean Slate) Act 2004. (see Pg 4)\u003Cbr>________________________________________________________________________\u003Cbr>________________________________________________________________________ |\n| --- |\n| Are you currently awaiting the hearing of any charges? Yes 􀀡 No 􀀡\u003Cbr>The Board reserves the right to contact authorities to verify any claim made. |\n\nCo-Curricula Activities  \nA commitment to the co-curricula life of the school is expected of successful applicants. Please indicate what commitment you would make to sport or cultural activities.  \nTamaki Coll. Application Employment Form Page 2  \nF. Referees  \nPlease provide names, addresses and phone numbers of three (3) referees, one of whom is a current or previous employing BOT member and/or Principal  \n1.    \nName  \nAddress  \nTelephone – Private Telephone – Business Ext  \nEmail  \nCapacity in which you have known this person:    \n2.  \nName  \nAddress  \nTelephone – Private Telephone – Business Ext  \nEmail  \nCapacity in which you have known this person:    \n3.  \nName  \nAddress  \nTelephone – Private Telephone – Business Ext  \nEmail  \nCapacity in which you have known this person:    \nI consent to the school seeking verbal or written information on a confidential basis about me from representatives of my previous employers and/or referees and authorise the information sought to be released to the school for the purposes of ascertaining my suitability for the position for which I am applying.  \nI understand that the information received by the school is supplied in confidence as evaluative material and will not be disclosed to me .  \nSignature:   Date:    \nTamaki Coll. Application Employment Form Page 3  \nCriminal Records (Clean Slate) Act 2004  \nThis legislation was enacted in May 2004. The act introduces a clean slate scheme. An individual is legally deemed to have no criminal record and s/he need not disclose convictions if the following criteria are satisfied:  \n1. S/he has not committed any offence within 7 (consecutive) years of being sentenced for the offence and  \n2. S/he did not serve a custodial sentence for the offence (this would exclude serious offences such as murder, manslaughter, rape and causing serious bodily harm) and  \n3. The offence was not a specified offence (specified o","cbCaipfjH7vepuQg","https://ap.wps.com/l/cbCaipfjH7vepuQg","pdf",112618,"English","# A. Personal Information\n# B. Educational Qualifications\n# C. Current Employment\n# D. Health\n# E. Convictions Against the Law\n# Co-Curricula Activities\n# F. 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