APPLICATION FORM

PLEASE TYPE OR USE BLACK INK OR BALLPOINT

SURNAME (in capitals) / First Names ( in capitals)
(underline the name you are usually known by)
Do you require a Work Permit to enter employment within the European Union?
(please circle)
Contact Details
Address / Telephone
Email address
NAME AND ADDRESS OF NEXT OF KIN
POSITION APPLIED FOR

EDUCATION SECONDARY

School Attended
(Name and Address) / Entered / Left / Leaving Certificate (or equivalent)
Subjects Taken
Subject
(Higher) / Result / Subject
(Lower) / Result

THIRD LEVEL (if applicable)

Qualifications Title of Award (Cert/Diploma/Degree/Professional Qualification or Higher) / Full/
Part-time / Duration / Grade Achieved (eg First Class Honours etc) / University/
College Attended / Awarding Body eg NUI, HETAC etc / Year of Award

ADDITIONAL TRAINING RELEVANT TO THIS POST (If applicable)

Title of Course Attended / Name of College/Training Centre attended / Full/
Part-time: / Content/
Details
of Course / Dates attended / Duration / Qualification attained (if relevant):

EMPLOYMENT

PRESENT OR MOST RECENT EMPLOYMENT

Name of Employer:
From: / To: / Full/Part Time:
Month/Year Month/ Year
Nature of Work/Main Responsibilities:
Other Positions Held by you in the Organisation:

PREVIOUS APPOINTMENTS (please include all previous appointments)

Start with the appointment which preceded that described above and work backwards through your career. Please include previous positions with your present employer.

Period in Months / Full/Part-time / Inclusive Dates
From To / Employer’s Name, Business and Location / Brief Job Description and Main Responsibilities / Reason for Leaving

Reasons for applying for this Post

In about 200 words or less, please give the reasons why you are applying for

INTERESTS

What are your leisure-time interests? If you have held any posts of responsibility in connection with these, please give details.

OTHER QUALIFICATIONS AND EXPERIENCE

If you have any qualifications and/or experience relevant to the job for which you are now applying, which are not given elsewhere on the form, please list here

PERSONAL CIRCUMSTANCES

Do you hold a current Full Driving License(Yes)No

Do you have access to a car? (Yes)No

DECLARATION
The nature of the job for which you are applying will bring you into direct contact with children and young people, either as service users in their own right or the children of service users.
As part of the YMCA’s Child Protection Policy the successful candidate will be asked to fill out a Garda Vetting Form which will then be submitted to the Garda Central Vetting Unit in Thurles.
We therefore ask you to sign the following declaration.
Declaration of a conviction will not necessarily mean disqualification from appointment. However, if it is subsequently found that you failed to declare a conviction, this will be regarded as gross misconduct which could lead to your employment being terminated.
The information you provide will remain confidential.
Please give details, including date, offence and sentence of all criminal convictions below:
If none, please write none and sign and date.
Date / Nature of Offence / Sentence
If required, I will complete a Garda Vetting Form.
I confirm that the information supplied in this Application Form is true and accurate.
Signed Date

REFERENCES

Please give the name and address of three persons (not relatives), one of whom should be your present or recent employer and whom you have asked to act as your referees.

No approach will be made to your current employer without your consent.

1.Name
Occupation / Address
Telephone Number
●Name
●Occupation / ●Address
●Telephone Number
2.Name
Occupation / Address
Telephone Number

This form, when completed should be returned to:

CLOSING DATE FOR RECEIPT OF APPLICATIONS is Tuesday April 3 2018 at 12 noon.

It is anticipated that interviews will be held on Thursday 5th April 2018