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MINISTRY OF EDUCATION AND HUMAN RESOURCES

EMPLOYMENT OF SUPPLY TEACHERS - SECONDARY


Application Form
1.

Supply Teacher for (specify subject)

2.

Surname: ...............................................................................................................................
(in Block letters)
Other Names: ........................................................................................................................
(in Block Letters)
Maiden Name (if applicable) ................................................................................................
Title: Mr/Mrs/Miss (Delete as appropriate)

3.

Date of Birth: ........................................................................................................................

4.

Full Address: ........................................................................................................................


................................................................................................................................................
Tel. No. (Home) ........................................... Mobile . Office .....

5.

Qualifications:
(a)

School Certificate Nov/Dec 19.

Subjects

O Level Jan/June 19.

Grade

Subjects

1. ...

..

..

2. ...

..

..

3. ...

..

..

4. ...

..

..

5. ...

..

..

6. ...

..

..

7. ...

..

..

8. ...

..

..

Checked
(b)

Grade

Checked

Higher School Certificate

A Level Jan/June 19 .....

Principal Level

Grade

Principal Level

1.

.......................................

...

1.

.................................... .

2.

......................................

...

2.

.................................... .

3.

......................................

...

3.

.................................... .

Subsidiary Level
1.
2.

......................................
......................................
General Paper
Checked

gp/Application Form/Supply Teacher Sec

...
...
...
Checked

Grade

(c)

Other qualifications (Academic, Technical, Professional)

Qualifications
(in case of degree whether
Hons/Special, Ordinary/General)

Date obtained

Examining
Institution

..................................................

.............................

........................

.................................................

.............................

........................

.................................................

.............................

........................

Checked

(d)

Special/Post Graduate Qualifications

..................................................

.............................

........................

.................................................

.............................

........................

.................................................

.............................

........................

Checked
(e)

Teaching Experience
From: ..

(f)

6.

To:

PSSA Registration: .. No.

I certify that:

(i)

*I am/am not working on a full time basis.

(ii)

The particulars given above are correct to the best of my knowledge.

* Delete where appropriate

.................................................
Date

gp/Application Form/Supply Teacher Sec

......................................................
(Signature of Applicant)

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