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1Personal Details

2Emergency Contact

3Right To Work In The UK

4Qualifications & Training

5References

6Medical Declaration

7DBS

8Declarations

9Overseas Police Check

10Safeguarding

11Rehabilitation of Offenders Act 1974

12Disqualification

13Payroll

14Signature & Application Submission

Your Personal Details

Full Name

Title First Middle (if any) Last

Preferred Name

Contact Number

Email Address

Enter Email Confirm Email

Address

House Number / Name Street Address City Postcode Country

NI Number

Date of Birth

DD slash MM slash YYYY

Emergency Contact Details

Full Name

First Last

Relationship to you

Mother, Father, Friend, Sibling, etc.

Contact Number

Right To Work In The UK

Immigration, Asylum and Nationality Act 2006.

Are you eligible to work in the UK?

Yes

Document Type

You have stated you are not eligible to work within the UK. Unfortunately, we are only able to work with those who are eligible. Please do not continue with this form. Contact us for more information.

Qualifications & Training

If you have any qualifications and/or training that you would like to add to your application, please add them below.

Are you a qualified teacher?

Teacher Reference Number

Do you give consent for Lexia to apply for a TRN and Prohibition Check with the Teaching Regulation Agency?

Yes

NQT Induction Complete?

Yes

Your Qualifications

Qualification	University/College	Date Awarded	Actions

There are no Records.

Maximum number of records reached.

Safeguarding Training

Training / Level Held	Provider	Date Awarded	Actions

There are no Records.

Maximum number of records reached.

References

Please provide us with your references. You must ensure you have your referee’s consent to share their contact information with us before you provide these details.

Choose which applies to you

The options below will change depending on the answer you provide. This is so we obtain everything we need based on your circumstances.

Most Recent Employer

Name of Employer	Name of Referee	Employment Date From	Employment Date To	Total Months in Employment	Actions

There are no Records.

Maximum number of records reached.

You must add 1 record.

Previous Employer(s)

Name of Employer	Name of Referee	Employment Date From	Employment Date To	Total Months in Employment	Actions

There are no Records.

Maximum number of records reached.

You must add at least 1 record.

Hidden

Total Employment Days

Hidden

Total Employment Months

Hidden

Check for Most Recent Employment Record

Hidden

Check for Previous Employment Record

Your employment references do not span the minimum 2-year requirement. Please either check the dates provided to ensure they are correct, or change which applies to you.

Thanks! Your employment references span the minimum 2-year requirement. You may now continue.

Your employment reference does not span the minimum 2-year requirement. Please either check the dates provided to ensure they are correct, or change which applies to you.

Thanks! Your employment reference spans the minimum 2-year requirement. You may now continue.

Character Reference

Name of Referee	Date Known Since	Date Known To	Total Months	Actions

There are no Records.

Maximum number of records reached.

You must add 1 record that spans 5 years or more.

I give consent for Lexia to contact my referee(s)

Yes

Medical Declaration

The Education (Health Standards) (England) Regulations 2003 state that “a person shall not be appointed to relevant employment if, having regard to any duty of the employer under the Equality Act 2010, does not have the health and mental and physical capacity for that employment.”

Lexia Education will treat all medical information provided with confidentiality and in-line with GDPR requirements.

Do you suffer from any conditions that may prevent or limit you from carrying out your employment duties?

Yes

Please provide details below

Please note: We may need to ask you to provide a letter from your GP confirming you are fit for work.

DBS Update Service

Do you have an enhanced DBS registered with the update service?

Yes

Do you have a DBS application in process with another organisation?

Yes

DBS Tracking Number

Please ensure this starts with "E/F"

Name of Organisation

Application for an Enhanced DBS Certificate

Due to the nature of the role for which you are applying, Lexia Education is required to process a new enhanced DBS application for you, if you do not already hold a DBS certificate, relevant to the role for which you are applying and registered online with the DBS update service.

Full Name

Prefix First Middle (if any) Last

What town were you born in?

Country of Birth

Have you ever changed SURNAME by marriage/deed poll/adoption/other reason?

Yes

Legal names only.

Your Birth Surname

Birth Surname	Date From	Date To	Actions

There are no Records.

Maximum number of records reached.

Your Other Surnames

Other Surname	Date From	Date To	Actions

There are no Records.

Maximum number of records reached.

Have you ever changed FORENAME by marriage/deed poll/adoption/other reason?

Yes

Legal names only.

Your Birth Forename

Birth Forename	Date From	Date To	Actions

There are no Records.

Maximum number of records reached.

Your Other Forenames

Other Forename	Date From	Date To	Actions

There are no Records.

Maximum number of records reached.

Address History

Please start by adding your current address. You can mark your current address when adding a new record below. We will need a 5-year continuous address history starting with your current address.

Your Addresses

Address	Current Address	Date From	Date To	Months at Address	Actions

There are no Records.

Maximum number of records reached.

Please add more addresses until we have a full 5-year address history.

Thanks! We now have your 5-year address history. You may now continue.

Hidden

Total Months

I give my consent to Lexia Education to carry-out an online status check via the DBS update service at least once every 12 months, or as needed in order to support their work finding services

Yes

Declarations

I have provided complete and true information in support of the application and I understand that knowingly making a false statement for this purpose is a criminal offence

Yes, I understand

Privacy Policy - I have read the Enhanced Check Privacy Policy for applicants and I understand how DBS will process my personal data and the options available to me for submitting an application

Yes, I have read the Enhanced Check Privacy Policy

Consent - I consent to the DBS providing an electronic result directly to the registered body that has submitted my application. I understand that an electronic result contains a message that indicates either the certificate is blank or to await the certificate which will indicate that my certificate contains information. I understand the registered body will then share this electronic result directly with Lexia Education

Yes, I give consent

I understand under the Keeping Children Safe in Education guidance, if I have not worked with children for 12+ weeks since registering with Lexia Education and my enhanced DBS certificate is not registered with the update service, I will be required to apply for a new enhanced DBS certificate before I am offered work

Yes, I understand

Please note: the total cost of a new DBS application via Lexia Education is £50 including all administration fees. Once paid, DBS payments are 100% non-refundable.

Overseas Police Check

Have you lived or worked outside of the UK for six months or more in the last 5 years?

Yes

Please provide details

Country	Date From	Date To	Actions

There are no Records.

Maximum number of records reached.

If you require an overseas police check, please find details on how to apply here.

Safeguarding

Please refer to the latest version of Keeping Children Safe in Education

As part of the Department for Education’s Statutory Guidance for schools and colleges on safeguarding children and safer recruitment, all supply staff are required to read and understood the latest version of “Keeping Children Safe in Education”, before providing work in the education sector.

I confirm that I will/have read and understood the latest version of ‘Keeping Children Safe in Education’

Yes, I confirm

You can find this on the UK GOV by clicking here.

I confirm that I will/have read and understood Lexia Educations Safeguarding Policy (available on the Lexia website)

Yes, I confirm

You can find this on our website by clicking here.

Rehabilitation of Offenders Act 1974 (Exemptions Order 1987)

Please refer to the latest version of Keeping Children Safe in Education

Due to the nature of the work for which you are applying, these posts are exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. You are therefore required to state whether or not you have any criminal convictions and cautions both ‘unspent’ and/or ‘spent’ (apart from protected convictions and cautions under DBS filtering rules). Successful applicants will be required to apply for a disclosure from the Disclosure and Barring Service.

Do you have any, or any pending convictions, cautions, reprimands or final warnings, which would not be filtered inline with current guidance?

Yes

The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are ‘protected’ and are not subject to disclosure to employers and cannot be taken into account. For guidance and criteria on the filtering of these cautions and convictions please see DBS filtering rules and the list of offences that will not be filtered policy documents. These documents can be provided by Lexia Education staff if further clarification is needed.

Please provide details of your criminal convictions and or cautions

Lexia Education will treat all information provided above with confidentiality and inline with GDPR requirements.

Disqualification

Childcare (Disqualification) and Childcare (Early Years Provision Free of Charge) (Extended Entitlement) (Amendment) Regulation 2018 and Childcare Act 2006.

Are you disqualified from regulated activity with children under the above regulations?

Yes

You have answered "Yes" to being disqualified from working with children. Unfortunately, we can only work with those who are NOT disqualified. Please do not continue this application. Contact us for more information.

Payroll

In order to receive pay for any work provided to you by Lexia Education, you will need to register with one of the below umbrella companies:

Generate: www.generate-fs.co.uk
ePayMe: www.epayme.co.uk
AZebra: www.azebra.co.uk

If you have a preferred umbrella company that is not listed, please let us know and we will confirm whether we are able to pay you through your chosen company.

Please note: Self-employed, Limited Company, PSCs, and Sole Trader are no longer accepted as a remuneration option**

I confirm I have received details (including any deductions) for all the above umbrella companies at my registration and acknowledge I will need to register with an umbrella company before I can be provided with, and paid for, any work.

Yes, I confirm

If your chosen umbrella company contacts us for a copy of your Right to Work and Identity documentation, do you give consent for us to provide them with a copy?

Yes

Signature & Application Submission

The information provided on this form and on any CV given, will be used by Lexia Education to provide you with work finding services. In providing this service to you, you consent to your personal data being included on a computerized database and consent to Lexia Education transferring your personal details to clients in order to meet legal and statutory auditing requirements. Lexia Education may check the information collected, with third parties or with other information held by us.

We may pass the information to certain third parties, to prevent or detect crime, to protect public funds, or in other way permitted or required by law. All information provided on this registration form will be handled in-line with our GDPR candidate privacy notice, available here.

Following the submission of this form, we will review the information provided to ensure it meets all requirements.

Signature

Consent

I have answered all questions to the best of my knowledge and wish to submit my application