WATERFORD CITY COUNTY COUNCIL

APPLICATION FOR:

Retained Firefighter Kilmacthomas Fire Station

Please return this form to the Human Resources Department, Waterford City and County Council, Floor 2 , Civic Office, Dungarvan, Co. Waterford so as to arrive not later than

4:00 p.m. on Thursday, 29th March, 2018

A. 1. Surname: ______First Name(s): ______

2. Home Address: ______

______

3.Telephone No: ______(Home) ______(Work)

Mobile:______E-mail Address:______

B.General Education:

Dates / Name of School / Examinations / Result
From / To / Or College / Taken (Subjects)
  1. Particulars of qualifications or Training courses Completed

(Please include photocopies of certs etc. ) :

College Attended / Qualification Obtained / Result / Year Obtained

D.Particulars of Work Experience: {additional information may be added on an A4 page}

From / To / Name of Employer / Particulars of Employment

Do you have a clean, unendorsed driving licence? Y/N

What category of vehicle are you licensed to drive? B C1CD1DEB

E.Leisure Interests, etc:

Please give details of membership of any Clubs, Societies, Associations, etc., including offices held at present, or in the past:

______

______

______

  1. Please state if you have any medical condition which would prevent you from giving regular and efficient service or which would hinder you carrying out the full range of duties of

Retained Firefighter

______

______

G.Any additional information you wish to give in support of your application:

______

______

______

H.If successful, when could you take up duty?

______

I.(i)Please give names and addresses of two persons to whom you are well known but not related who will supply a character reference:

(1)______(2) ______

______

______

(ii)Do you have any objection to WaterfordCityand County Council contacting your previous employer(s) for references? YES NO

(iii)Declaration : I hereby certify that the above information is true and correct to the best of my knowledge and belief.

Signature: ______Date: ______

Latest date for receipt of application forms - not later than

4:00pm on 29th March, 2018

N.B. Please submit application form (x 4 copies) together with up to date Curriculum Vitae (x 4 copies) with photocopies of Certificates and Qualifications etc. (x 4 copies).

Please insert your name AND ADDRESS in the box below and return this sheet with your application if you require an acknowledgement of receipt. An acknowledgement will not be sent if this sheet is not completed and returned with your application form.

I hereby acknowledge the safe receipt of completed application form of

Please insert Name and Address

in this Box

______

______

______

______

______

______

for the position of RETAINED FIREFIGHTER

Signed: ______Date: ______

Human Resources Dept.

Should acknowledgement of your application not be received within 7 days of postage, please contact the Human Resources Department.

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