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PRIMARY CARE SERVICES
HR Department
Railway Street
Navan
Co. Meath
Tel: (046) 9076452/9076490
Fax: (046) 9071052
Email:
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Principal in General Practice – Dundalk, Co. Louth
Closing date for receipt of applications is 12 Noon Thursday 11/08/2011
Competition Reference No: 2011/025
1. Name in full: ......(Block Letters) / For Office Use:
2. Postal address: ......
......
......
3. Tel No: (Work) ...... Tel No: (Home) ......
Mobile No: ……………………… Email address …………………………….
4. Do you hold a current driving license / Yes / No / If so, what class (s) ......
General Education:
Examinations Taken: / Dates: / Grades Achieved:No. Honors No. Passes / Name of School:
Academic, Professional or Technical Qualifications:
1. Full-time Courses:
Qualification Held: / Dates:From/To: / Grade Achieved: / Name of Conferring Body: /
Academic, Professional or Technical Qualifications:
2. Part-time/Evening Courses:
Qualification Held: / Dates:From/To: / Grade Achieved: / Name of Conferring Body: /
3. Short-term Courses:
Qualification Held: / Dates:From/To: / Grade Achieved: / Name of Conferring Body: /
5. Spare time activities and interests:
______
6. Any other information to support your application:
______
Referees:
Please give names and addresses of your two most recent employers from whom references may be obtained. (Please indicate if you do not wish us to contact your current employer, without your consent).
Name: ______
Address: ______
______
______
Occupation: ______
Tel No: ______
Name: ______
Address: ______
______
______
Occupation: ______
Tel No: ______
Give particulars in date order of all employment and experience. All time since leaving school or college should be accounted for.
From: / To: / Position Held and Brief Description of Duties:(Please indicate reason for leaving) / Full Name and address of Employer:
I the undersigned, hereby declare all the particulars given above to be true.
Signature of applicant: ______Date: ______
Re: Principal in General Practice – Dundalk, Co. Louth
Dear Doctor,
Further to this application for the above post, please supply the following information:-
Do you have full registration in the Register of Medical Practitioners of Ireland? ______
What is your registration number? ______
Date of full registration? ______
Under which section of Part 4 of attached Particulars of Office - Professional Qualifications do you claim eligibility and give details?
4 (a)
4 (b) (i)
4 (b) (ii)
4 (b) (iii)
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PRIMARY CARE SERVICES incorporating G.P., Pharmacy, Dental and Optometry Units