PERSONAL:

SURNAME: ___________________________________________ CHRISTIAN NAMES:___________________________________

FULL POSTAL ADDRESS: ___________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

TELEPHONE NUMBERS::

BUSINESS:____________________________ PRIVATE:_____________________________

CELL PHONE: _________________________ FAX:_________________________________

N.Z.TRAINED TEACHERS CERTIFICATE:

Date of Certificate: _____________________

CURRENT PRACTISING CERTIFICATE:

Expiry date: ___________________________

PRESENT APPOINTMENT OR LAST POSITION HELD:

POSITION: _________________________ SCHOOL: ___________________________

EDUCATION DISTRICT: ___________________________________________________

DATE APPOINTED: ______________________________________________________

REFEREES**

1. Name: _____________________________________________

Address: _____________________________________________

____________________________________________________

Phone: ______________________________________________

2. Name: ________________________________________

Address: ________________________________________

_______________________________________________

Phone: ________________________________________

PART II SPECIFIC QUALIFICATIONS:

List Areas of Specialisation at Teachers College, ASTU papers, University papers, Attendance at

In Service courses (dates and duration) other relevant studies, etc

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

CONFIRMATION:

i certify that information given in this application and my C.V. is to the best of my knowledge, correct.

I understand that this may be verified, by the B.O.T. The B.O.T. may contact other schools or sources to verify information.

I understand that me acceptance of the above position indicates my firm resolve to support Opunake Primary School Charter, Policy statements and Guidelines, and me job requirements.

Applicants signature: ________________________________________ Date: ___________________________