RELIEVER APPLICATION FORM

Personal Information
Title
Christian Name/s
Preferred Name
Last Name
E-mail Address
Phone
Home Address
Mobile
Date of Birth
Marital Status
Spouse / Partner Name
I am eligible to work within NZ - I am a NZ Resident or have NZ Citizenship*
If no, do you have a current Work Permit? Please provide expiry details.
Faith Perspective
This position is a tagged position, which means under our Integration Agreement, being a committed Christian is a requirement for all positions. Please therefore briefly outline your Christian faith journey.*
Please also provide details of your current Church/Fellowship involvement.*

Qualifications & Registration Details
Tertiary Institute studied
Qualifications and Year completed
Portfolio Website URL (if applicable)
NZ Teacher Registration Number
Expiry Date
MOE Number
Teacher Registration Status
Have you completed the MOE mandatory module on Physical Restraint Guidelines?*
If 'Yes', please attach a copy of your certificate
Physical Restraint Certificate

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Employment History
Present or Most Recently Held Position (Please include Title / Type and Salary Scale)
Date Appointed
Employer
Previous Service (Begin with most recent) Please include Position - Class Level(s) - Salary Level - School - Dates
Total Years of Certificated Service
Past & Present Professional Responsibilities (Give details concerning the nature and extent of professional responsibility and leadership exercised in present and past positions, if applicable.)
Relevant Experience, Abilities and Further Training (Give details of qualifications / further training - other than academic - special skills and experience relevant to the position.)
Preferences
Year Level(s) and/or Subject(s) Preferred:
If you are successful, when would you be available to start?
Any days you are not available?
Referees (Please list up to 2, including your Pastor / Minister and a previous employer.)
Referee 1 - First & Last Name
Position & Employer
E-mail Address
Contact numbers (Landline and Mobile)*

Referee 2 - First & Last Name
Position & Employer
E-mail Address
Contact numbers (Landline and Mobile)*
Additional RefereesThe applicant hereby authorises the Principal of Bethlehem College (or delegate) to contact the following additional referees (indicated with a “Yes” response below) regarding the applicant’s application for a position of employment at Bethlehem College.
Current / Most Recent Employer (or senior staff person in that employment)

YesNo
Previous Employer (or senior staff person in that employment)

YesNo
Minister or Leader of your Church

YesNo
Supporting Documents - CV, Cover Letter & References
Please upload your supporting documents below.
Files up to 2MB each for file types .pdf .doc .docx .rtf .odt
Cover letter

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CV

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Reference

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I hereby confirm that all information supplied in this employment application is true, complete and correct.
Name
Date
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