- Laws of Fiji

Last Updated: 1 December 2016

[FTR 10,329] FTRB 4 APPLICATION FOR LIMITED AUTHORITY TO TEACH

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) 3100165
FRTB4 APPLICATION FOR LIMITED AUTHORITY TO TEACH

1.	PERSONAL DETAILS
				Photo

	Family Name:
	Given Name:
	Title eg Ms/Mr/Mrs/Miss: Male □ Female □
	Date of Birth: Licence 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 for individual is $15 and lodgement fee is $10 and for institutions the fee is $250. The fees must paid before your application can be processed.
	•	Payments may be made to cover a minimum one calendar year period to a maximum 2 calendar year period.
	•	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. Forms sent directly to Headquarters are 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 are 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. This is to be attached 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 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 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)

10.	PRINCIPALS/HEAD TEACHERS’S RECOMMENDATION
	(a)	Teaching Positions Offered
		Class/Form:______________________
		Role:____________________________________________
		Main Subject/Duties:____________________________________________
		Other Subject/Duties:____________________________________________
		Suitability of Position: The position is temporary and for a specific contract term form_________ months/years until_________ (date/month/year). These are clear expectations for the role in this position having prime responsibility for planning, teaching, assessing, evaluating, lesson diagnosis, remedial and reporting for a group of students.
	(b)	Suitability of Applicant
		I consider that the principal applicant is of good character, fit and has the necessary skills, aptitudes and experience to perform all the Teaching duties specified in the contract of service.
	(c)	PRINCIPAL/HEAD TEACHER’S DETAILS
		Full Name:_____________________
		School:________________________
		Designation:_____________________
		Signature:_______________________
		Registration Number:______________
		Date Signed:_____________________
	(d)	Manager’s/Board of Governor’s Recommendation
		I, the undersigned support the endorsement of___________________
		Name of Applicant
		to teach at________________________ after proper
		Name of the School
		discussion and approval by the Board members.
		Full Name:___________ School:___________
		Designation:_______________ Signature:_______________
		(Manager)
		School stamp__________________________________________

	(e)	MINISTRY OF EDUCATION APPROVALS
		(SEO, DEO, DPE, DSE)
		I the undersigned fully support the endorsement of this application.
		Full name:__________________ Registration No._______________
		Designation:_____________________ Date signed:_______________
		Ministry 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		□	□