Form: REG-01Application for Registration as a TeacherApplication for Registration as a Teacher in accordance with the Teaching Council (Registration) Regulations 2016

Please indicate the Route of Registration for which you are applying: (insert tick mark ✓).

All applicants must complete pages 1 – 7

Route 1 Primary: Also complete Appendix 1

Route 2 Post- Primary: Also complete Appendices 1 & 2

Route 3 Further Education:

Route 4 Other: Also complete Appendix 1

Please read the Guidance Notes before completing this application form

V.2/2018

1

Form: REG-01

SECTION A — PERSONAL DETAILS

PPS No.:

Teacher/Payroll No.:

Title:

Surname:

Forename:

Gender: Male Female Other

Date of Birth:

Nationality:

Previous Name (if applicable):

Address for Correspondence:

Important Note

This must be a residential address. Notices served under Section 62 of the Teaching Council Act, 2001 will be served to this address

Eircode:

Mobile Phone No:

Home Phone No:

Email:

SECTION B – AUTHORISATION FOR THE TRANSFER OF QUALIFICATIONS/REGISTRATION DETAILS TO PAYMASTER FOR CURRENT OR PROSPECTIVE EMPLOYERS

I, , hereby authorise the Teaching Council to provide details relating to my qualifications to my paymaster (i.e. The Department of Education and Skills or ETB.)

Yes No

D D/ M M / Y Y Y Y

Recorded for statistical purposes

INSERT YOUR NAME HERE

Prefix

Prefix

(e.g. Birth name or change of name by deed poll)

V.2/2018

2

Form: REG-01

SECTION C — QUALIFICATIONS

In the grid below please enter the exact title of each qualification e.g. Bachelor of Education, Higher Diploma in Education, Master of Arts.

Degree Qualification or Equivalent

Teacher Education Qualification (only complete if this was a postgraduate course)

Title of Qualification

College/University Attended

Awarding Authority

Date Commenced

Year Awarded

Duration of Course (insert number of years)

Full Time:

Part Time:

Full Time:

Part Time:

Number of ECTS credits (in entire qualification)

Subject(s) in which teaching methodologies were taken

Level of Award on National Framework of Qualifications (e.g. Level 8)

Final Result (Hons/Pass/GPA e.g. 2.1)

If you have further qualifications, please provide details below:

Online Access to Qualification Details (where available)

Note: If your transcripts are available on Digitary, please login to your account and share the transcript document(s) with info@teachingcouncil.ie for a minimum of 4 weeks.

Website address or URL: e.g. www.ucd.ie/verify

Person ID/Username:

Document ID/Password: To permit access to your transcripts

V.2/2018

3

Form: REG-01

SECTION D – FIT AND PROPER PERSON ASSESSMENT

CHARACTER REFERENCENote: This section must be signed by a professional person in a position of academic responsibility.

Please refer to the Guidance Notes before completing this section.

I hereby certify that, in my professional capacity, I have known ______NAME_______________ for one academic year in the last five years and that I know of nothing in his/her character that renders him/her unfit for the teaching profession.

Name of Professional Person (in block capitals):

Signature of Professional Person:

Date:

Occupation/Position of Professional Person:

Address of Professional Person:

Teaching Council Registration Number (if applicable):

VETTINGPlease refer to the Guidance Notes before completing this section.

If you are applying for Vetting together with Registration, please continue to complete and submit this form. The Teaching Council will process your application on receipt of your vetting result from the National Vetting Bureau (NVB) and the fulfillment of any overseas police clearance requirements (if applicable).

Vetting Reference Number:

Date of Vetting Disclosure (if received):

OVERSEAS POLICE CLEARANCEI have provided/enclose overseas police clearance documentation:

Provided Enclosed N/a

P L E A S E A F F I X T H E O F F I C I A L S C H O O L /CO L L E G E STA M P I N T H I S B OX

T E C 0 0 1 - 2 0 1 8 0 4 2 6 - 0 0 0 0 0

D D/ M M / Y Y Y Y

V.2/2018

4

Form: REG-01

SECTION E —TEACHING SERVICE

Please provide information below about your current/most recent teaching service/approved experience (if applicable) excluding school placement:

School Name and Address/ Place of Employment:

School Roll Number:

Current Position:

Teaching hours/number of hours of employment per week:

Subjects Taught (Post-primary and Further Education only):

Duration of Service:

Signature of School Principal/ HR Manager/ Director of ETB

Date:

Other Relevant Experience

Employer:

Duration of Service:

Role/Position:

P L E A S E A F F I X T H E O F F I C I A L S C H O O L /CO L L E G E STA M P I N T H I S B OX

B eg i n n i n g : D D/ M M / Y Y Y Y

B eg i n n i n g : D D/ M M / Y Y Y Y

To : D D/ M M / Y Y Y Y

To : D D/ M M / Y Y Y Y

D D/ M M / Y Y Y Y

V.2/2018

Form: REG-01

V.2/2018

SECTION F – English Language Requirement

Englishismyfirstlanguage

OR

1. Ienclosewiththisapplicationacertifiedcopyofaqualification(teacher education or undergraduate) acquired and examinedthrough the medium of English.

OR

2. IencloseacertifiedcopyofanIELTS(InternationalEnglishLanguageTestingSystem)certificateattestingknowledgeintheEnglishlanguage with a score of 7.0 or above.

OR

3. I enclose evidence of living and practicing in a professional capacitythrough the medium of English in a country that has Englishrecognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears.

OR

4. I enclose evidence of living and undertaking a programme oflearning through the medium of English in a country that has Englishrecognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears.

The Teaching Council reserves the right to independently verify the scores with IELTS. All components of the IELTS test must be attempted at the same sitting. The test must have been undertaken no more than five years prior to the date of submission or the applicant must provide evidence of having resided and worked/studied on a full time basis in an English speaking environment since having completed the evaluation. The IELTS certificate (where required) must be supplied with the registration application form, registration cannot be finalised without this document.

5

6

Form: REG-01

SECTION G – DECLARATION

The following questions should be answered by entering a tick (✓) in the appropriate box. In any case where the response to a question is Yes, full details should be given on a separate sheet and referenced to the appropriate question.

1. Have you been convicted of any criminal offence in the State or elsewhere? (Under theNational Vetting Bureau (Children and Vulnerable Persons) Act 2012 certain convictions arenot required to be disclosed).

2. Have you been the subject of any adverse outcome or finding or sanction following aninquiry or disciplinary procedure by any other professional or regulatory body in the Stateor elsewhere? (including the equivalent of the Teaching Council in any other jurisdiction).

3. Have you been the subject of any adverse outcome or finding or sanction following aninquiry or disciplinary procedure by an employer (current or previous) in the State orelsewhere? (This includes situations where workplace restrictions were imposed following an inquiry or disciplinary procedure).

4. Are you currently the subject of any pending proceedings or investigation of the kinddescribed in 1, 2 or 3 above, including any pending investigation being carried out by theHealth Service Executive or TUSLA, the Child and Family Agency?

5. Is there any other relevant information that the Council should know about which may have a bearing upon your suitability to register?

I declare that:

(i) the information provided by me in all sections of this application is true and accurate.

(ii) I understand that further to a vetting disclosure, the Teaching Council may seeksubmissions, documentary and other evidence to enable the Council to satisfy itself that I am a fit and proper person to be admitted to the Register of Teachers.

(iii) I understand that the Council may impose conditions on my registration where it deemsappropriate.

(iv) I understand that the Teaching Council shall refuse to register me if it is not satisfied that I am a fit and proper person to be admitted to the Register.

(v) I understand that the Teaching Council may seek information from me, or any otherrelevant person, to verify any of the information submitted by me for the purpose of this registration application.

(vi) I understand that it is an offence to make a false or fraudulent declaration ormisrepresentation and that it could also lead to a complaint to the Council’s InvestigatingCommittee.

(vii) I understand that as a registered teacher I will be responsible for upholding and promotingthe standards of the profession as set out in the Codes of Conduct and Practice for Registered Teachers. Relevant information would include any involvement in activitieswhich could bring the reputation of the profession into disrepute.

(viii) I have read and understood the Council's Privacy Statement as published on the Council'swebsite.

SIGNATURE OF APPLICANT:

Yes No

Yes No

Yes No

Yes No

Yes No

D D/ M M / Y Y Y Y

V.2/2018

BLANK PAGE

7

Form: REG-01

SECTION H – REGISTRATION FEE/ METHOD OF PAYMENT

The registration fee that must be submitted with this form is €90. This fee covers the cost of registration for the first year of registration. There is no additional fee for vetting. Please choose one of the following payment options. PLEASE DO NOT SUBMIT CASH.

Option 1: Debit/Credit Card

Master Card: Visa (Credit or Debit):

Card Number:

Expiry Date: -

CVV/CVN*: *The last three digits of the security code on the reverse of the card

Cardholder’s name (please print name):

Cardholder’s signature:

NOTE: This page will be securely disposed of once processed.

Option 2: Cheque, Postal Order or Bank Draft made payable to The Teaching Council.

I enclose a: Cheque Postal Order Bank Draft

V.2/2018

BLANK PAGE

8

Form: REG-01

SECTION I – CHECKLIST

Please complete and sign this checklist prior to submitting this application form. If the application form is not complete it will be returned to the applicant.

1. I have read the Guidance Notes prior to completing this application form.

2. I have fully completed this application form and have entered N/A in any field that is notapplicable.

3. I have included a certified copy of my marriage certificate/deed poll to facilitate a namechange (if applicable).

4. I have provided proof of qualifications by submitting:

(a) if trained in the State, certified copy transcripts for every year of my qualifications or

(b) if trained outside the State, a letter from the Department of Education and Skillsconfirming that my qualifications have been recognised or

(c) if trained outside the State, my qualifications have been assessed by the TeachingCouncil previously. My assessment number is _______________________.

5. I have completed Vetting through the Teaching Council or have recently submitted aVetting application to the Teaching Council or I enclose a Vetting application now.

6. I have included the €90 registration fee.

7. I understand that the information provided by me on this application form will be used tocontact me for registration purposes (including postal, email and SMS correspondence).

8. I understand that after a period of 3 months from the date the application is received,that if items of documentation or other items are still outstanding this application will be declared invalid and the Council will return the entire application and supportingdocumentation (including the registration fee).

SIGNATURE OF APPLICANT:

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

The Council reserves the right to verify any documentation submitted in support of an application and to seek additional documentation should it be required to determine suitability for registration.

Signature of applicant:

Date:

Please send the completed application form including all mandatory documentation to:

The Teaching Council Block A

Maynooth Business Campus Maynooth Co. Kildare W23 Y7X0

Ireland

D D/ M M / Y Y Y Y

D D/ M M / Y Y Y Y

V.2/2018

9

Form: REG-01

APPENDIX 1 – REGISTRATION WITH CONDITIONS (POST QUALIFICATION PROFESSIONAL PRACTICE)

Please refer to the Guidance Notes before completing this section.

ROUTE 1 PRIMARY AND ROUTE 4 OTHER – Please respond to all of the following statements:

I previously held full registration with the Teaching Council.

I have completed Droichead.

If yes, this will be verified against Teaching Council records.

I have completed Probation prior to September 2010.

If yes, this will be verified directly with the Department of Education and Skills:

I, , authorise the Teaching Council to contact the Department of Education and skills to verify the above information.

I have completed Probation after September 2010.

If yes, please enclose Form C and statement of competence from Limerick Education Centre if not previously submitted.

I have completed the Induction Workshop Programme.

If yes, this will be verified against Teaching Council records.

I have completed a formal Induction process in another country.

If yes, you are required to apply to the Teaching Council for the assessment of that process to determine eligibility for recognition in Ireland if not previously assessed. Please contact the Council for full details.

ROUTE 2 POST PRIMARY – Please respond to all of the following statements:

I previously held full registration with the Teaching Council.

I have completed Droichead.

If yes, this will be verified against Teaching Council records.

I have completed Post-qualification Experience as outlined in the Guidance Notes.

If yes, please enclose Form B if not previously submitted.

I have completed the Induction Workshop Programme.

If yes, this will be verified against Teaching Council records.

I have completed a formal Induction process in another country.

If yes, you are required to apply to the Teaching Council for the assessment of that process to determine eligibility for recognition in Ireland if not previously assessed. Please contact the Council for full details.

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

INSERT YOUR NAME HERE

V.2/2018

10

Form: REG-01

APPENDIX 2 – POST-PRIMARY CURRICULAR SUBJECTS

Curricular Subject ChecklistPlease refer to the Guidance Notes before completing this section

In order to register with the Teaching Council under Route Two (Post-primary), you must meet the requirements for at least one post-primary curricular subject. Please indicate with a tick the subject you are applying to register in.

Please refer to the Teaching Council’s curricular subject (Post-primary) requirements before you apply:

■ Accounting

■ Agricultural Economics

■ Agricultural Science

■ Applied Mathematics

■ Art (including Crafts)

■ Biology

■ Business

■ Chemistry

■ CSPE (Civic Social and PoliticalEducation)

■ Classical Studies

■ Information and CommunicationsTechnology (ICT)

■ Construction Studies

■ Economics

■ Engineering

■ English*

■ French*

■ Geography

■ German*

■ Greek (Ancient Greek)

■ Hebrew Studies

■ History

■ Home Economics(Scientific and Social)

■ Italian*

■ Japanese*

■ Arabic

■ Gaeilge/ Irish*

■ Latin

■ Mathematics

■ Music

■ Physical Education

■ Physics

■ Physics andChemistry

■ Religious Education

■ Russian*

■ Spanish*

■ Design andCommunicationGraphics (formerlyTechnical Drawing)

■ Technology

* LANGUAGE SUBJECTS - RESIDENTIAL EXPERIENCE AND LINGUISTIC COMPETENCEThis section applies to those applying for language subjects only including Gaeilge/Irish. Please tick as appropriate

My residential experience and Linguistic Competence (minimum B2 on the Common European Framework of Reference for Languages (CEFR)) is listed on my enclosed qualification transcripts

or

I enclose with this application evidence of both my residential experience and Linguistic Competence (minimum B2 on the Common European Framework of Reference for Languages).

V.2/2018

CEFR

CEFR

Residency

Residency