Graduate and Registered Teacher Programmes
Expression of Interest in Employment Based Routes to QTS

Title
  
Name
  
Former Name (if applicable)
  
Address
  
Postcode
  
Home Telephone
 
Work Telephone
 
Email
  
National Insurance No.
  
Sex
  
Date Of Birth
  
Current Age (years and months)
  
Nationality
  
Do you require a work permit
  
Ethnic Group
 
Disability
  
Disability Registration No.
 
EMPLOYMENT AND EXPERIENCE
Teaching Employment History
Please include a list which includes

Institution name and type (i.e. Highgate Primary)

Subject level taught and age range

Start and end dates of employment
  
Please list details of your experience of working with children and young people and/or using your subject knowledge in previous employment.

Please state paid or voluntary

full or part-time

and the duration in years and months
  
Are you presently employed either in Full or Part-time work?
  
If Yes
   
Name of Employer
  
Job Title
 
Description of duties
  
Start date
 
EDUCATION AND QUALIFICATIONS
GCSE or equivalent
    

English - List qualification, grade and date awarded
i.e.. GCSE, B, 06/06/1995

  
Maths - List qualification, grade and date awarded
i.e.. GCSE, B, 06/06/1995
 
'A' Level or equivalent (e.g. NVQ or GNVQ)
    

List Subject, qualification, grade and date awarded
i.e.. English, A LEVEL, B, 06/06/2000
Science, A LEVEL, B, 08/06/2000

 
Higher Education - First Degree
    
Institute of study
  
Degree Course
  
Qualification(s) Obtained
 
Degree Class
 
Dates of study from...
   ...to
Please list main and subsidiary subjects studied and proportions as percentages over the duration of the course
  
Higher Degrees
 
Institute of study
  
Degree Course
  
Qualification(s) Obtained
 
Dates of study from...
   ...to
Please list main and subsidiary subjects studied and proportions as percentages over the duration of the course
  
Teacher Training
Have you ever gained any teacher or lecturer training qualifications either in Britain or overseas? (E.G. City & Guilds 730, PGCE (FE), TDLB D33/34. If so state:
  
Institution of study
Qualification(s) Obtained
Dates of study from...
 ...to
Age Range Trained
 
Have you ever failed a QTS Assessment?
AVAILABILITY
Are you available to work full-time?
If NO please explain why not
Please state which subjects you intend to teach
(These must normally relate to your degree and represent a National Curriculum subject)
 1 2
Please choose the age group you are interested in teaching
DECLARATION
I confirm that the information provided on this Expression of Interest form is correct. I also confirm that I am not aware of anything which prevents me from starting a Teacher Training Programme.

Notes:
To be eligible for a Graduate Teacher Programme you must (i) you must hold a Degree level qualification usually related to the subject(s) you want to teach; (ii) you must be able to work full-time for a whole school year (or equivalent part-time up to 2 years); (iii) you must not have any serious criminal convictions or be otherwise excluded from the teaching profession.
You must have GCSE Grade C or equivalent qualifications in English Language and Mathematics to be awarded QTS The Robert Owen Consortium in partnership with mentoringworks will organise approved tests (subject to suitability) if you do not hold these qualifications.
All applications are subject to final approval by the Teacher Training Agency.
If you have any queries about this form please contact administration on 01934 842919.
Please send your completed form to: Graduate and Registered Teacher Programmes, 202a High St, Worle, Weston Super Mare BS22 6JE
Mentoringworks is committed to equal opportunities. We aim to eliminate unfair discrimination against anyone in our recruitment and selection procedures. We encourage applications from groups presently under-represented in the teaching profession.
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