Personal Details


Reference Details

Checks and Disclaimers


  • About you
  • Qualifications
  • References
  • Disclaimers
  • Declaration

About you

Please complete all highlighted sections. If a section is not applicable please indicate N/A to show that it has not been accidentally omitted. Your completed registration form is part of our registration process and the contents of which will be assessed alongside your documentation, references and formal interview in-line with the DfE Safer Recruitment regulations. Please do not hesitate to raise any questions or concerns with your consultant.


Maiden / previous name(s): (Please provide details of any name changes)

First name

Date of Birth



Landline telephone number

Mobile telephone number

Preferred contact number

Email address

Next of Kin Details



Contact number

What type of work are you looking for?

Type of work

Permanent vacancy?

Long term / interim temp work?


Professional qualifications (degree level or higher)


Year qualified

NCTL / IFL number (if appropriate - formerly DfE number)

Safeguarding & Child Protection

Please provide details of your safeguarding training and experience:

Experiences & Preferences

Please list the subjects and/or year groups you are qualified to teach or support

Please list the subjects and/or year groups you have experience teaching or supporting

Outside of education qualifications, do you have any additional skills/qualifications?

Reference 1 (most recent employer)

Details of two teaching referees must be supplied and must include your most recent employer, referees must also be in a position of senior leadership within the setting. If your references cover less than two years of employment, please provide a third referee.

Name of employer

Job title

Employer address

Employer telephone number

Employer email address

Reference 2

Name of employer

Job title

Employer address

Employer telephone number

Employer email address

Reference 3

Employer name

Job title

Employer address

Employer telephone number

Employer email address

Criminal Records & Disciplinary Action Disclosure

Please note that, as working with children is exempted from the Rehabilitation of Offenders Act 1974, you must disclose details of all previous convictions and cautions including ‘spent’ offences. The existence of a criminal conviction or past disciplinary action will not necessarily be a bar to the completion of your registration with Elementa Support Services Ltd. However failure to disclose such information may lead to the rejection of your application or termination of your registration as appropriate. Please answer Yes or No as appropriate

Have you ever been, or are you at present, subject to disciplinary action?

Have you ever had a complaint made against you and / or been investigated in relation to a child safeguarding issue?

Have you ever been, or are you currently, subject to performance management?

Have you ever been convicted or cautioned in relation to any criminal offence, or is any police enquiry on-going, or prosecution pending?

Have you or do you presently have information relating to the disqualification by association regulations? [October 2014: DfE Safer Recruitment Regulations] which would prevent you working with children?

If you have answered YES to any of the questions above, please provide full details including what happened, when and any outcome and involved Local Authorities/Education provisions:

Enhanced With Barred List DBS Check

As you are registering with Elementa Support Services Ltd to obtain work in schools, we are required to carry out an ‘enhanced with barred list’ check with the Disclosure and Barring Service (“DBS”). This can be undertaken in two ways: 1. We can check with the DBS ‘online update service’ if you have registered for an on-line account with the DBS. We will also need to see the original DBS certificate. 2. We can carry out a new ‘enhanced with barred list’ check with the DBS. If you wish Elementa Support Services Ltd to carry out the DBS check by method 1, please complete the information below.

Are you currently registered with the DBS ‘online update service’?

Disclosure Reference no:

Disclosure Date of Issue:

Position Applied For: (as appears on Disclosure)

Post Code of Candidate: (as appears on Disclosure)

Name of Employer: (as appears on Disclosure)

Registered Body’s Name and Address:

By choosing

Print date (to be completed by candidate)

Please note that Elementa Support Services Ltd operates strictly in accordance with the DBS Code of Practice in relation to DBS checks.

Payment information

Bank name

Sort code

Account number

Name on account

National insurance number

Equal Opportunities

Elementa Support Services Ltd is committed to promoting equality of opportunity for all applicants. We aim to create a recruitment environment in which all individuals are able to make the best use of their skills free from discrimination and harassment. We do not discriminate against applicants on the basis of any protected characteristic including gender, sexual orientation, marital or civil partnership status, gender reassignment, race, colour, nationality, ethnic or national origin, religion or belief, disability or age.

Data Protection Act

Elementa Support Services Ltd complies with the Data Protection Act 1998 in processing and storing information provided by applicants. Please confirm below to confirm that you consent Elementa Support Services Ltd processing and storing your personal data, in order to complete your registration and find you temporary and/or permanent assignments. Some information, including criminal convictions and cautions, investigations or complaints involving child protection issues, former disciplinary action and/or on-going enquiries or pending prosecutions, whilst not automatically preventing you from working with children, may need to be shared with schools before they will consider offering you work.

By selecting

Please confirm below to confirm that you give your consent to Elementa Support Services Ltd sharing any such information, including your DBS certificate and references, with schools, academies or local authorities which may offer you work.

By selecting

Please sign below to confirm that you consent to Elementa Support Services Ltd disclosing your personal details including your name, address, date of birth, qualifications, references, NI number etc, to : a) any school, academy, local authority at which you have worked or by whom you have been offered work, for the purposes of the Single Central Record and/or b) an statutory body under the Children Act 2004 in the event of an investigation involving child safeguarding.

By selecting

Please note that, if you do not provide all of the consents requested above, Elementa Support Services Ltd may not be able to complete your registration.

Child Protection and Safeguarding

You are responsible for familiarising yourself and complying with the child protection / safeguarding policies and procedures and any other relevant policies and procedures of all schools / academies / local authorities at which you are placed. By printing your name in the box below you confirm you will ensure I fulfil the responsibility above.

Print name

Agency Worker Regulations

Agency Worker Regulations [AWR] require agencies to maintain records detailing a candidates working history with individual schools. If Elementa Support Services Ltd offer you work at a school you have previously worked at which we were not already aware of please sign below to confirm you will notify us. Elementa Support Services Ltd cannot be held liable for AWR implications if we are not kept informed of an agency workers assignment history.

By selecting

Please confirm below to confirm that:

i) the information you have provided on this registration form is complete and accurate to the best of your knowledge and that you understand that completion of your registration is subject to receipt of satisfactory references, medical assessment and DBS check. ii) you understand that giving false information or failing to disclose any significant information could result in the rejection or termination of your registration.

Print name (to be completed by the candidate)

Select today's date (to be completed by the candidate)