- Laws of Fiji

Last Updated: 1 December 2016

[FTR 10,328] FTRB 3 APPLICATION TO RENEW REGISTRATION

FIJI TEACHERS’ REGISTRATION BOARD
MINISTRY OF EDUCATION, NATIONAL HERITAGE CULTURE
AND ARTS

Level 4 Harm Bing Narm Building Brewster Street, Toorak Private Mail Bag Suva, Fiji		Phone: (679) 3100125 3100119 3311175
		Fax: (679) 31001655
FRTB3 APPLICATION FOR RENEW REGISTRATION

1.	PERSONAL DETAILS
			Photo
	Family Name:
	Given Name:
	Title eg Mr/Mrs/Ms/Miss: Male □ Female □
	Date of Birth: TPF/EDP FTRB No
	Place of Birth: Country:
	Postal Address:
	Residential Address:

Section:

Primary

□

Secondary

□

Other

□

	Contact Details
	Telephone (W)
	Telephone (H)
	Mobile
	E-mail

2.	PAYMENT DETAILS
	Please note the following—
	•	Registration is for a calendar year — 1 January to 31 December. There is no pro rata rate for part year.
	•	The registration fee of $30 must be paid before your application can be processed.
	•	Cash can be made payable to cashiers located at Lautoka, Ba, Rakiraki, Nausori, Sigatoka, Savusavu and Labasa Education Office, Headquarters Marela House, Bucalevu Secondary School, Vunisea Secondary, Fiji College of Advanced Education and Levuka Public Secondary School. However, should you wish to send your forms direct to Headquarters, you need to make payments using bank draft, bank-cheque or TMO.
	•	For application lodged from overseas, payment must be in Fiji dollars.

Please tick appropriate box(es)	2009	2010	2011	2012	2013	2014
Registration required for year(s)

Payment amount: $_____ for □ years (please specify number of years).

Payment total: $_____ FTRB Trust Account No:_________

Receipt No:_______ Post Office Payment Made:___________

	3.	CURRENT SCHOOL APPOINTMENT
		Name of School/Institution:______________________________
		Commencement date:__________________________
		Full-time □ Part-time □ Reliever □
		Nature of appointment if not classroom teacher:__________________

	4.	EDUCATION
		Tertiary Teaching/Non Teaching and Professional Development Qualifications: Certificates/Diploma/Certificates of Participation/Degrees etc [Please attach Certified True Copies or if original copies it will be returned after processing]

Name of Course	Institution	Country	Years/months of completion/participation	Remarks

RECORDS OF TEACHING SERVICE

Position	School/Institution Employing Authority	Country	Full-time/Part-time	Date From	Date To

6.	MEDICAL CLEARANCE FORM
	•	All Existing Teachers are to fill the Medical Clearance Form provided by the Fiji Teachers Registration Board.
	•	All New Teachers to provide a full Medical Clearance from a Medical Officer of their choice.
7.	GOOD CHARACTER CHECK FORM
	•	All existing teachers are to complete the Character Check Form and attach it with the application form.
	•	New teachers are to get Police Clearance by filling the Clearance Form from the Police Department and pay $22.50 to Police Head Quarters.
	The following person(s) are recommended to provide for the supporting endorsement: Registered Teacher, Registered Church Minister, Registered Pundit or Registered Molvi, Registered Pastor, current sitting or retired Magistrates and Judges.
8.	PERMISSION TO RELEASE INFORMATION
	(a)	I hereby authorise the Teacher Registration Board or its delegates to make enquiries and exchange information with any Teacher Registration Authority, employer/relevant institution concerning my registration to teach or other related matters.
	(b)	I also give my consent and permission if relevant for the Teacher Registration Board or its delegates to access my academic records.
	Signature of Applicant: _________________ Date: _________________

9.	DECLARATION
	(i)	Have you ever had your registration, licensing or status as a teacher or any other entitlement to teach cancelled or suspended or withdrawn in Fiji or in any other country?	Yes □ No □
	(ii)	Have you ever been refused registration, or licensing as a teacher in Fiji or in any other country?	Yes □ No □
	(iii)	Have you ever been dismissed from a teaching position in Fiji or any other country?	Yes □ No □
	(iv)	Have you ever been, or are you currently, the subject of disciplinary proceedings, or any other action that might lead to such proceedings, in relation to your employment in Fiji or in any other country?	Yes □ No □
	(v)	Have you ever been convicted or found guilty of any offence?	Yes □ No □
	(vi)	Have you ever been charged with any offence, whether or not you have been found guilty?	Yes □ No □
	(vii)	Are there any charges in relation to any offence pending?	Yes □ No □

I,________________________________________________________________________
(Full name of applicant)
of________________________________________________________________________
(Full address of applicant)
Declare that I have completed and read this application for Registration form and that the information I have provided is true and correct. I acknowledge that a person making a false declaration is liable on conviction to a fine not exceeding $20,000 or to imprisonment for a term not exceeding 5 years (Fiji Teachers Registration Act 2008).

Declared by___________________ at________________
(Signature of applicant) (Place)
This_________________day of__________________
(Day) (Month and year)
Before me____________________________________________________________
(Full name of witness)
Signed_____________________________________________
(Signature of witness)
		Phone (H)_______________
		Phone (W)_______________
		Mobile_______________
(To be witnessed by one of the following: Justice of the Peace/Commissioner for Oaths/Education Officer, Barrister and Solicitor)

	10.	PRINCIPAL’S/HEAD TEACHER’S RECOMMENDATION
		I affirm that_____________________________________has met the
		(Applicant’s Full Name)
		Following criteria.

		NO	YES
•	This teacher is of good character and fit to be a teacher	□	□
•	This teacher has performed a satisfactory teaching experience	□	□
•	This teacher’s performance has been assessed as satisfactory on all the satisfactory Teacher Dimension	□	□
•	This teacher has satisfactorily completed the necessary Professional development	□	□

Full Name:____________________________ School:____________________________
Designation:_____________ Registration No:_____________
Signature:____________________________ Date Signed:______________
School Stamp:___________________________________

	MINISTRY OF EDUCATION APPROVALS
	(SEO, DEO, DPE, DSE)
	I the undersigned fully support the renewal of the Teaching Certificates of

	(Applicant’s Full Name)
	Full Name:_____________ Registration No_________________
	Designation:________________ Date Signed:________________

	Ministry of Education
	Stamp

This is your CHECKLIST — please use it to ensure that you have completed all the entries in your application form. Please tick

			APPLICANT	OFFICE USE ONLY
1.	Have you completed the form in full		□	□
2.	Have you attached documentary evidence of true copy		□	□
	•	Birth Certificates	□	□
	•	Academic Records/Professional Development undertaken	□	□
	•	Full Medical Report — New Teachers	□	□
	•	Medical Clearance Form — Existing Teachers	□	□
	•	Character Check Form — existing teachers	□	□
	•	Police Clearance — new teachers	□	□
3.	Have you had these documents certified as True and Accurate copies of the originals on every page by an authorised person		□	□
4.	Have you signed the permission to release information statement		□	□
5.	Have you signed the Declaration Section		□	□
6.	Has the declaration section been witnessed		□	□
7.	Have you attached the Fee Payment receipt with the paid stamp		□	□