Join Supply List Please complete the following form details to register on our supply list. Title: Choose from list Mrs Miss Ms Mr First name: Last Name: Tel. No. Address: Town/City: County/Borough: Choose from list Darlington Durham Hartlepool Middlesbrough North Yorkshire Redcar and Cleveland Stockton on Tees Post Code: Email: Date of Birth: Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year: Capability: Select any areas in which you have any experience and/or qualifications. (please tick all that apply) Administrator Classroom Assistant Cleaner Cook Creche Worker Deputy Manager Manager Nursury Nurse Nursery Assistant Play Leader Play Worker Playgroup Worker Special Needs Support Assistant Teaching Assistant Settings: Select any settings in which you are keen to work. (please tick all that apply) Creche Day Nursery Holiday Playscheme Out Of School Club Playgroup Pre-School School Areas where I could work: Select the areas of Tees Valley you are able to work. (please tick all that apply) Darlington Hartlepool Middlesbrough Redcar and Cleveland Stockton on Tees Availability: Check the box next to all the days of the week you could be available and enter the starting and finishing hours you would be able to work on those days. Monday from to Tuesday from to Wednesday from to Thursday from to Friday from to Saturday from to Sunday from to Do you have an enhanced police check disclosure form? Yes     No Qualifications: Experience Brief: Education Brief: Cover Letter: NOTE: The following information is strictly confidential and will under no circumstances be viewed by potential employers or any other members of the public. The information will simply be used for statistical monitoring purposes by your local Early Years Development and Childcare Partnership. Gender: Male      Female Are you aged 40 or over?: Yes      No Do you have a disability or special need?: Yes      No Are you registered disabled?: Yes      No Where did you hear about this website?: Choose from list Advert Press article Leaflet Word of mouth Recommendation Exhibition stand Radio Other Ethnicity: Choose from list White White - Irish White - Other Mixed - white/black Caribbean Mixed - white/black African Mixed - white/Asian Mixed - other Chinese Asian/Asian British - Indian Asian/Asian British - Pakistani Asian/Asian British - Bangladeshi Asian/Asian British - other Black/black British - Caribbean Black/black British - African Black/black British - other Other Not Known Employment Status: Choose from list Employed - Small/Medium firm (1-249 employees) Employed - Large firm (over 250 employees) Self employed Still in Education Unemployed - less than 6 months Unemployed - 6-11 months Unemployed - 12-23 months Unemployed - 24-35 months Unemployed - 36+ months Current Qualifications: Choose from list None Below NVQ1 NVQ1 or equivalent NVQ2 or equivalent NVQ3 or equivalent NVQ4 or above Other Not known               © Copyright 2002 Tees Valley Children's Information Services & AES Ltd. Please read our Terms [home] [find a job] [providers section] [local links] [join supply list]