PLEASE COMPLETE These Details at the top of each page
Surname
/ First Given Names /
Position
/ EUCAPA Coordinator
/ CARA Adapted Physical Activity Centre Ltd

ITT South Campus, Tralee, Co. Kerry Tel. 066- 714 5646

Email: Website: www.caraapacentre.ie /

PLEASE READ CAREFULLY THE INSTRUCTIONS GIVEN BELOW

§  Complete all sections of this form carefully, in black ink or typeface

§  Do not leave any section of this form blank

§  You may submit a CV along with the application form

§  Do not refer to a CV for critical information on qualifications or experience

§  Ensure all academic qualifications are accurately and clearly stated

§  Any queries to: Niamh Daffy: 0667145646/

§  Return completed form to:

Niamh Daffy- National Manager

CARA Adapted Physical Activity Centre

ITT South CampusTralee

Co Kerry, Ireland

to arrive not later than

12.00 noon on Wednesday 6th July 2011

NOTE: Applications received after the closing date will not be accepted

Screening and shortlisting will take place on the basis of information presented on this application form only.

1.

/ APPLICATION FOR THE POST OF: /

EUCAPA Conference Coordinator

1.2

/ SURNAME: / /

GIVEN NAMES:

/
/ /

BLOCK CAPITALS PLEASE

/ /

FULL NAME PLEASE

1.3

/

ADDRESS:

/
1.4 /

CONTACT INFORMATION

/ / /

TELEPHONE NUMBERS

/

( )

/

MOBILE

/

(DAY)

/

Area Code Tel No

/ /

If Available

(EVENING)

/

( )

/

FAX NUMBER

/
/

Area Code Tel No

/ /

If Available

EMAIL ADDRESS

/ / /

If Available

/ /

2

/
SECOND LEVEL EDUCATION
/ / /
/
SCHOOL NAME
/ /

FROM:

/ /

TO:

/
/ ADDRESS / / /
3. /
THIRD LEVEL QUALIFICATIONS – (HETAC/NCEA, PROFESSIONAL OR UNIVERSITY ACCREDITED ETC) – (use additional sheet if necessary)
3.1 / NAME OF THIRD LEVEL INSTITUTION ATTENDED:
ADDRESS:
STUDIED FROM: / STUDIED TO:
TITLE / GRADE / AWARDED BY / CONFERRED
MONTH/YEAR
FINAL YEAR SUBJECTS:
3.2 / NAME OF THIRD LEVEL INSTITUTION ATTENDED:
ADDRESS:
STUDIED FROM: / STUDIED TO:
TITLE / GRADE / AWARDED BY / CONFERRED
MONTH/YEAR
FINAL YEAR SUBJECTS:
4 / LIST RELEVANT COURSES/SEMINARS ATTENDED WITH DATES, DURATION AND EFFECTIVENES
5 / PLEASE OUTLINE IN DETAIL YOUR EXPERIENCE/FAMILIARITY WITH COMPUTER PACKAGES/SYSTEMS/APPLICATIONS

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/ Employment : Please state in order of most recent employment. As the information given in this section is used for screening / shortlisting please give full details of your past employments, leaving no gaps. If currently, or in the past you were not in employment, please state so. Do not refer to a CV. If there is insufficient space on this page, please give further details on a continuation sheet, using the same format.

7.1

/ EMPLOYMENTS Please state in order of most recent employment
POSITION HELD:
Total Number of Months
FROM (Month & Year) / TO (Month & Year)
BRIEF DESCRIPTION OF DUTIES:
REASON(S) FOR LEAVING

7.2

/ EMPLOYMENTS
POSITION HELD:
Total Number of Months
FROM (Month & Year) / TO (Month & Year)
BRIEF DESCRIPTION OF DUTIES:
REASON(S) FOR LEAVING

7.3

/ EMPLOYMENTS
POSITION HELD:
Total Number of Months
FROM (Month & Year) / TO (Month & Year)
BRIEF DESCRIPTION OF DUTIES:
REASON(S) FOR LEAVING

7.4

/ EMPLOYMENTS
POSITION HELD:
Total Number of Months
FROM (Month & Year) / TO (Month & Year)
BRIEF DESCRIPTION OF DUTIES:
REASON(S) FOR LEAVING

7.6

/ EMPLOYMENTS
POSITION HELD:
Total Number of Months
FROM (Month & Year) / TO (Month & Year)
BRIEF DESCRIPTION OF DUTIES:
REASON(S) FOR LEAVING

8.

/ PLEASE PROVIDE DETAILS OF EXPERIENCE IN EVENT MANAGEMENT AND/OR COORDINATION

9

/ OTHER RELEVANT INFORMATION IN SUPPORT OF YOUR APPLICATION:
10 / REFEREES:

(Please note that three referees must be given)

10.1 / MUST BE FROM CURRENT EMPLOYMENT
NAME OF REFEREE: / PERMISSION TO CONTACT / YES / NO
BUSINESS ADDRESS:
TELEPHONE NUMBER:
POSITION HELD IN ORGANISATION:
10.2 / MUST BE FROM EMPLOYMENT OTHER THAN CURRENT EMPLOYMENT
NAME OF REFEREE: / PERMISSION TO CONTACT / YES / NO
BUSINESS ADDRESS:
TELEPHONE NUMBER:
POSITION HELD IN ORGANISATION:
10.3 / OTHER REFEREE
NAME OF REFEREE: / PERMISSION TO CONTACT / YES / NO
BUSINESS ADDRESS:
TELEPHONE NUMBER:
POSITION HELD IN ORGANISATION:
YES / NO

11. Do you hold a full drivers licience?

12. Licence Type: ______

13.

/ DECLARATION
/ Any applicant who canvasses or seeks to canvass (by himself / herself or through a third party) any member of the Selection Board in support of his/her candidature shall be disqualified by the Selection Board. Thus I fully recognise that canvassing will disqualify my application.
I hereby certify that all statements given by me in this application form or in correspondence or interview are true and correct and without omission. I accept that any mis-statement or material omission from this form will disqualify my application and invalidate any offer of employment.
SIGNATURE OF APPLICANT / DATE

Where did you hear about this position?

CARA Website 1

Local Sports Partnership Newsletter/Website 1

NGB Website 1

Other, Please Specify ______1

Please Note: Closing Date: 12.00 Noon on Wednesday 6th July. Applications received after the closing date will not be accepted

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