- Laws of Fiji

Last Updated: 1 December 2016

[FTR 10,326] FTRB 1 APPLICATION FOR PROVISIONAL 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
FRTB1 APPLICATION FOR PROVISIONAL REGISTRATION

1.	PERSONAL DETAILS
	[Names as they appear on your Birth Certificate]		Photo

	Family Name:
	Given Name:
	Title eg Mr/Mrs/Ms/Miss/Doc/Proff:
	Date of Birth: TPF/EDP
	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.
	•	A lodgement fee of $10 is required
	•	A registration fee of $30 must be paid before your application can be processed with $10 lodgement fees.
	•	Payments may be made to cover a minimum of one calendar year or a maximum of 3 calendar years.
	•	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 overseas applications, payment must be made in Fijian dollars or the equivalent.

	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:________________________
	Answering question 4 and 5 is optional for Overseas Applicants Only.

4.	FIJI CITIENSHIP/RESIDENCY/WORK VISA
	Are you a Fiji citizen		Yes□ No□
	If not a Fiji citizen: citizenship___________________
	Do you hold permanent resident status in Fiji?		Yes□ No□
	Do you hold a visa to work in Fiji?		Yes□ No□

5.	ENGLISH LANGUAGE REQUIREMENT
	Eligibility for provisional registration requires:
	•	Proficiency in English and either Fijian, Hindi or Urdu.
	•	Teaching qualifications in any one of the following countries — Australia, Canada, United Kingdom, New Zealand, United States or any country recognised by the Ministry of Education.
	•	Lacking the above, evidence of English being the medium of instruction in all your Primary, Secondary and Tertiary Education must be produced.
	•	Have you passed your IELTS test?_____________ Where?_____________

6.	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

8.	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.
9.	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.
10.	PERMISSION TO RELEASE INFORMATION
	(a)	I hereby authorise the Fiji Teachers 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 Fiji Teachers Registration Board or its delegates to access my academic records.
	Signature of Applicant:________________________________________________
	Date:________________________________________________

11.	DECLARATION
	(i)	Have you ever had your registration, licensing or status as a teacher on 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 or 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 □
	(viii)	Are you declared an undischarged bankrupt?	Yes □ No □
	(ix)	Are you paying child/spousal/parental maintenance?	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______________________________		Phone (H)__________
(Signature of witness)		Phone (W)__________
		Mobile___________
(To be witnessed by one of the following: Justice of the Peace/Commissioner for Oaths/Education Officer, Barrister and Solicitor)

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		□	□

Please do not submit your applications until all sections of the form have been completed and all required documents are attached.