Application Form Garda Trainee (Form B)

Application Form – Garda Trainee (Form B)

NOTES FOR APPLICANT

Please read these instructions before completing this form.All answer fields are compulsory.

(a)Completion of this form does not guarantee acceptance to the position of Garda Trainee.

(b)Application for employment as a Garda Trainee is made on the understanding that the Commissioner of An Garda Síochána retains the right to reject any applicant.

(c)Applicants should note that members of An Garda Síochána are liable to be allocated or transferred to any station or centre within the State at the discretion of the Commissioner of An Garda Síochána.

(d)The full name provided at Section 1 (a) should match that on your original Birth Certificate unless otherwise officially changed due to marriage, civil partnership, adoption or deed poll. In the event it is different, your Birth Certificate name along with any other previous or other names should be provided at Section 1 (b). Your original Birth Certificate along with any other documentation to support the above will be required at a later date.

(e)Complete this form using a computer. Handwritten forms will not be processed. Where insufficient space is available to answer fully a particular question, a separate typed sheet (to include the question number) should be used and attached to the form.

(f)Applicants must attach a recent passport size photo in the box provided. Your name and date of birth should be printed on the reverse of the photo.

(g)Failure to provide complete and accurate dates of birth and full postal addresses,including postcodes will result in un-necessary delays in the processing of your application.

(h)Failure to complete this form fully and truthfully will result in the rejection of your application.

(i)An Garda Síochána has aderogation under Part 5 of the Disability Act 2005.

(j)All information contained herein is dealt with under the provisions of the Data Protection Act,1988, as amended.

Application Form – Garda Trainee (FormB)

Applicant:

(a)Full Name(s):

(b)Previous or other name(s) (if applicable):

(See explanatory note (d) of Notes for Applicant)

(c)Nationality: (d) D.O.B. Date Month Year

(e)Place of Birth:

(f)Present Occupation:

(g)PPS Number:(h) E-mail Address

(i)Present Address:

(j)Phone Numbers: (at present address)

(at work)(Contact/Mobile Number)

(k)Home Address (if different from above):

(l)Please provide, in chronological order, all former addresses since birth (including permanent, temporary and college addresses excluding present/home addressabove) and include approximate dates:

Full Postal Address / From / To

2.Name of next-of-kin:

Address of next of kin:

Telephone number:

Note: In the following Questions 3 to 10, the full and complete current/last known addresses including postcodes are required for all named relatives (including deceased) where applicable. It is advisable thatyouinvestigate all avenues such as the births, deaths & marriages registry and/or their website, local church baptismal records and local library records should you experience difficulty obtaining same.

3.Applicant’s Father, Mother & Spouse/Civil Partner/Partner: (including step-parents if applicable)

Father / Mother / Spouse/Civil Partner /Partner
(if applicable)
(Please X appropriate box)
Surname
First name
Previous/Maiden
Name(s) (if applicable)
Date of Birth
Occupation
Nationality
Full Postal Address

4.Applicants children (all children including adult children), if applicable:

Name / Full Postal
Address/Previous Address / Date of Birth

5.Please provide details of your child/children’s mother/father, (including deceased)if applicable anddifferent from listed:

Name / Date of Birth / Full Postal Address

6.Please providein Chronological Order,(including deceased)details for all your Brothers, Sisters, Half-Brothers/Sisters,Step-Brothers/Sisters if applicable:

Surname / First name / Date of Birth / Full Postal Address / Occupation / Relationship
to you

7.Please providein Separate Family and Chronological Order(including deceased) details, for all your Grandparents, Aunts and Uncles(i.e. your parents Brothers/Sisters) if applicable:

Surname / First name / Date of Birth / Full Postal Address / Occupation / Relationship
to you
(i.e. Paternal or Maternal)

8.If you have a Spouse/Civil Partner/Partnerplease provide details below of their Father/Mother/Step-Father/Step-Mother(including deceased) if applicable:

Spouse’s/Civil Partner’s/Partner’s Father / Spouse’s/Civil
Partner’s/Partner’s Mother
Surname
First Name
Previous/Maiden Name(s)
(if applicable)
Date of Birth
Place of Birth
Occupation
Nationality
Full Postal Address

9.Please providein Chronological Order,details for all your Spouse/Civil Partner’s/Partner’s Brothers, Sisters, Half-Brothers/Sisters, Step-Brothers/Sisters (including deceased)if applicable:

Surname / First name / Date of Birth / Full Postal Address / Occupation / Relationship to your Spouse/Partner/Civil Partner

10.Please provide in Separate Family and Chronological Order(including deceased)details for your Spouse/Civil Partner’s/Partner’s Grandparents, Aunts and Uncles(i.e. their parents Brothers/Sisters), if applicable:

Surname / First name / Date of Birth / Full Postal Address / Occupation / Relationship to your Spouse/Partner/Civil Partner(i.e.Paternal or Maternal)

11.Education and other Qualifications:

(a)Please list in chronological order commencing with Secondary Level, the names of Schools, Colleges you have attended:

Nameof School/College / Full Postal
Address / Year
From To /

Name of Course
Overall Grade achieved

(b)Leaving Certificate:Yes / No YEAR:

TYPE: Established Applied Other

(Please X appropriate box)

If other, please provide details:

(c)Please provide details of your Leaving Certificate/Other results below:

Subject / Enter Gradein Appropriate Box Below / Subject / Enter Grade in Appropriate Box Below
Higher / Ordinary / Other / Higher / Ordinary / Other

(d)Are you qualified in any other Trade/Profession?Yes/No

If “Yes” give details:

(e)Do you speak/read any other languages?Yes/No

Please list details below:

Language / Level of Competency

12.Particulars of Employment:

(a)Please provide details of your present employer,if applicable:

1.Name
2.Full Postal Address
3.Phone number and/or email address / Your Position Held / Date commenced Employment

Should you be successful in the Competition your local Garda Management may wish to contact your current employer for a reference in advance of your Interview with them.Please confirm by ticking the appropriate box whether permission is granted/refused to contact your present employer:

Permission GrantedPermission Refused

(b)Please provide, in chronological order, details of all previous employers (including part-time employment) for the last 10 years, if applicable:

(Please account for any gaps in employment)

1.Name
2.Full Postal Address
3.Phone number/email address / Your Position Held / Dates employed / Reason for leaving
From / To

(c)Have you ever resigned in lieu of dismissal or been dismissed/dischargedfrom any employment?

Yes/No

If yes,please provide name of employer, date and reason for same:

13.Interaction with Garda/Police:

Failure to disclose fully and truthfully any interactions with Garda/Police/Defence Forces,including any interaction under the Juvenile Liaison Officer Scheme (JLO), regardless of the outcome,may result in the rejection of your application.

(a)Have you ever been involved in any capacity ina Garda/Police investigation, (excluding in your role as a Garda Reserve, if applicable)?

Yes/No

If yes, please provide details:

(b)Have you ever been arrested and/or taken into Garda/Police custody regardless of outcome? Yes/No

If yes, please provide details:

(c)Have you ever been charged with a crime/offence?Yes/No

If yes, please provide details:

(d)Have you ever been summonsed to appear in Court?Yes/No

If yes, please provide details:

(e)Have you ever been convicted of a crime/offence by a Court or a Commanding Officer of the Defence Forces? Yes/No

If yes, please provide details:

(f)Is any charge or summons at present outstanding against you?Yes/No

If yes, please provide details:

14.Previous Applications and/or Garda Reserve Service:

(a)Did you ever previously apply for admission to An Garda Síochána? Yes/No

If yes, please provide details of the year and stage attained, specifically stating if your application was rejected by the Commissioner.

(b)Are you or have you ever been a member of the Garda Reserve? Yes/No

If yes, what Garda Station are/were you attached to?

(c)In your role as a Reserve Garda are you or have you ever been subject of a Disciplinary Investigation? Yes/No

If yes, please provide a brief summary of the investigation including the outcome if known:

(d)If you are no longer a member of the Garda Reserve, please state the reasons why:

15.Medical History:Any medical information that is pertinent to your application that you do not wish to disclose here can be disclosed directly to the examining practitioner in the Occupational Health Department or on the questionnaire which you will be required to complete if called to medical stage.

(a)Do you have any disability, disease or illness?Yes/No

If yes, please provide details:

(b)Are you taking any medication on a regular basis?Yes/No

If yes, please provide details:

(c)Have you ever been hospitalised?Yes/No

If yes, please provide details:

16.General:

(a)Please list spare-time activities/achievements in which you have an interest. Indicate your involvement, giving names of any organisation or clubs of which you are currently a member:

(b)Are you a member of any Political Party or Organisation?Yes/No

If yes, please provide full details:

(c)Are you the holder of a Private Security Authority (PSA) Licence, Public Service Vehicle (PSV) Licence or ANY licence, permit or designated certificate issued by a Court?

Yes/No

If yes, please provide full details:

17.(a)Garda Reference (not essential)

Please provide the Name and Station of any member of An Garda Síochána known to you but not related to you who would be willing to recommend your application. If the member is no longer serving please provide their current contact details.

Name / Station/Contact Details

(b)Academic Reference (essential)

Please provide the nameand contact details of any member of the academic staff at your School, College, Institute, University, etc whom you nominate as a referee. This person should not be related to you.

Name / Full Postal Address / Institute/College / Occupation
Tel/Mobile:
Email:

(c)General References (one of which to be a previous employer)

Please provide full details of two refereeswho have known you for at least five years who would be willing to recommend your application. If you have never been in employment please provide full details of two referees who have known you for at least five years and are willing to recommend your application:

Referees listed at (c) should not be a member of An Garda Síochána, not related to you, not from the same Institute/College as listed at (b)above nor should they be from the same employment.

References should be attached, where available.

Name / Full Postal Address / Approx. Age / Occupation
Tel/Mobile:
Email:
Tel/Mobile:
Email:

18.Declaration by Applicant:

I hereby declare that I fulfil all the requirements set-out in the Garda Síochána (Admissions & Appointments) Regulations, 2013, and that the information given in this form is correct and I hereby give my permission for enquiries to be made to establish such matters as age, qualifications, experience and character and for the release by other people or organisations of such information as may be necessary to An Garda Síochána for that purpose. I also acknowledge that I have read and understood the Notes for Applicants on Page 1.

Signature of Applicant: ______Date: ______

Witness:______Appointments Office, Garda HQ

Staff No:______Date:______

Please ensure that all sections are completed in FULL.

Any anomalies or missing information will result in unnecessary delays in processing the application. Failure to complete the form fully and truthfully WILL result in rejection of your application.