NQT Application Form
Please Enrol Me As A Full Member of the NASUWT
Please enter all responses after the corresponding colon.
My Details
Surname:
First name(s):
Title (e.g. Mr, Mrs, Ms, etc):
Home tel:
Mobile No:
E-mail address:
Date of birth:
Residential address:
Teaching Qualifications
Name of college/university:
Qualifications:
DCSF No. (if known):
Date of teaching qualification or expected date of qualification:
I am currently on a course to gain Qualified Teacher Status (Yes/No):
Type of course:
Employment If Post Secured
Name of school/college:
Address:
Postcode:
Sector or phase (Please answer yes to one only)
Nursery (yes/no):
Infant (yes/no):
First Primary (yes/no):
First Junior (yes/no):
Middle Primary (yes/no):
Middle Secondary (yes/no):
Primary (yes/no):
Junior (yes/no):
Secondary/Post-Primary (yes/no):
Special Primary (yes/no):
Special Secondary (yes/no):
6th Form (yes/no):
FE (yes/no):
HE (yes/no):
Other (please specify):
Name of Local Authority/Education and Library Board/Employer:
Post held (Please answer yes to one option only)
Teacher (yes/no):
Supply Teacher (yes/no):
Teacher in Central Services (yes/no):
Other (please specify):
Subject Specialism(s) (if appropriate):
Direct Marketing
In order to provide you with details of NASUWT membership services it is necessary to allow NASUWT approved service providers to process membership data.
I consent to the use of this information for the purposes described above(yes/no):
Monitoring
The NASUWT is committed to ensuring equality of opportunity for all, irrespective of gender, ethnic origin, disability, sexuality, religion or age. The following information will be used by the NASUWT to monitor and ensure the effective delivery of its services. Information will be processed and treated in confidence and in accordance with the provisions of the Data Protection Act 1998.
Do you have a disability/impairment? (yes/no):
If Yes, which of the following categories best describes your disability/impairment?
Chronic medical conditions (e.g. epilepsy, diabetes, ME, asthma) (yes/no):
Hearing impairment/deafness (yes/no):
Mental health difficulties (e.g. depression, schizophrenia, phobias) (yes/no):
Mobility impairment (yes/no):
Learning difficulties (yes/no):
Visual impairment/blindness (yes/no):
Other impairment (yes/no):
(please specify):
Which of the following best describes your ethnic background?
(Please answer yes to one option only)
Asian or Asian British
Bangladeshi (yes/no):
Indian (yes/no):
Pakistani (yes/no):
Other Asian background (yes/no):
(please specify):
Black or Black British
African (yes/no):
Caribbean (yes/no):
Other Black background (please specify):
Mixed Heritage
White & Asian (yes/no):
White & Black African (yes/no):
White & Black Caribbean (yes/no):
Other mixed background (yes/no):
(please specify):
White or White British
English (yes/no):
Irish (yes/no):
Scottish (yes/no):
Welsh (yes/no):
Other White background (yes/no):
(please specify):
Other Ethnic Group
Chinese (yes/no):
Other ethnic group (yes/no):
(please specify):
Gender (male/female):
Are you transgender? (yes/no):
Which of the following best describes your religion or belief?
(please answer yes to one option only)
Baha’i (yes/no):
Buddhist (yes/no):
Christian (yes/no):
Hindu (yes/no):
Jain (yes/no):
Jewish (yes/no):
Muslim (yes/no):
Rastafarian (yes/no):
Sikh (yes/no):
Zoroastrian (yes/no):
None (yes/no):
Other religion or belief (yes/no):
(please specify):
Do you define yourself as: (please answer yes to one option only)
Bisexual (yes/no):
Gay (yes/no):
Heterosexual (yes/no):
Lesbian (yes/no):
AUTHORISATION
Signature:
Date:
By completing and signing this application form you are confirming your explicit consent for the information to be processed and treated in accordance with the Data Protection Act 1998.
Please Complete This Form and Return It To
NASUWT
FREEPOST BM 2337
Hillscourt Education Centre
Rose Hill
Rednal
Birmingham
B45 8BR
