Comhairle Chontae an Longfoirt
Longford County Council
Aras an Chontae, Great Water Street, Longford.
Tel: (043) 33433304e-mail:

CHECK-LIST FOR APPLICANTS FOR THE

POST OF RETAINED FIREFIGHTER

LANESBORO FIRE BRIGADE

Please Tick (√) as appropriate

(This is a check list, original required only – do not attach to application form)

1. Application Form (original & 3 photocopies) □

2. Acknowledgement Sheet (original only) - if you wish your application to be

acknowledged, please complete. □

3.  Garda Vetting Form – (original only) which should be accurately completed,

signed at “Signature of Applicant” and returned to this office with your application. Please do not sign at “Authorised Signatory”.

You do not need to get this completed or signed by the Garda. □

4. Authorisation Form, (original only) which must be completed by you in

order for your family doctor to supply your medical history to the

Council’s Medical Advisor, in the event that you are successful and a

position is offered to you. You are only authorising your doctor to release information, you do not need to attend your Doctor . □

5. Document confirming that you live and work within a 2 mile radius of

Lanesboro Fire Station (original only). □

6. Document confirming that your employer is willing to release you to attend

to the duty of Retained Firefighter (original only). □

Signed: ___ Date:

Please print name here: ______


Comhairle Chontae an Longfoirt
Longford County Council
Aras an Chontae, Great Water Street, Longford.
Tel: (043) 3343304e-mail:

APPLICATION FORM

RETAINED FIREFIGHTER LANESBORO

Closing Date: Close of business on Wednesday, 20th July, 2016

4 Copies of Application Form must be submitted.

Responsibility for ensuring timely and correct delivery of applications rests with the applicant.

Candidates who send their applications by post should see that they are posted in sufficient time to ensure delivery not later than the latest time for acceptance.

Allegations that any application form or letter relating to it has been lost or delayed in the post will not be considered by the Local Authority unless a Post Office Certificate of Posting is produced in support of such allegations.

Completed applications should not be returned by fax.

All application forms received will be acknowledged.

Title: Mr. Ms.

Please Tick (√) as appropriate

Name in Full:______

(BLOCK LETTERS)

Residential Address: ______

______

Address for Correspondence

if different from above:______

(BLOCK LETTERS)

______

Contact Telephone Numbers: Business.______

Home. ______

Mobile. ______

Email : ______

GENERAL EDUCATION
School or College
Attended / Period / Examination Taken (with dates) / Result
(Pass or Honours)

ACADEMIC, PROFESSIONAL OR TECHNICAL QUALIFICATIONS (if any):

Full Title of qualification awarded including discipline / Year of Entry & Year Degree /Qualification Awarded
Ord. Or Hons. Level Degree / Grade Awarded
Honours/ Pass Eg. 1st class hons, 2.1,
pass etc / Subject(s) in Final Examination / Full name & address of University, College or Examining Authority

EMPLOYMENT RECORD

From / To / Name and Address
of Employer / Grade or Position Held. Type of Employment or Experience
(Short Description)

Have you any previous experience working with a Fire Service? Yes No

Please supply details in Employment Record.

Please tick (√) as appropriate

ACHIEVEMENTS / EXPERIENCE

Please indicate any particular achievement/experience, which you consider an Interview Board, should be aware of when assessing your application.

SUPPORTING ADDITIONAL INFORMATION

______

______

______

______

MEMBERSHIP OF LOCAL AUTHORITY

Are you now, or have you been at any time a member of a local authority or harbour authority?

Yes □ No □

If so, give date you ceased to be such a member ______

PUBLIC SERVICE PENSION

Do you have an entitlement to any preserved pension or any preserved lump sum or any other retirement benefit or have received or are in receipt of retirement benefits under a pre-existing public service pension scheme of which you were/are a member?

Yes □ No □ Is so, give details of same ______

VOLUNTARY REDUNDANCY

Have you ever accepted voluntary redundancy/early retirement from a local authority or any public service organisation by which you were employed? Yes □ No □

If so, give details of same ______

DO YOU REQUIRE A WORK PERMIT/WORKING VISA? Yes □ No □

REFERENCES

Please give details of the names of two responsible persons, to whom you are well known but not related (These names should be employers from whom the Council can request a reference. These should include your current and former employer, where possible.)

NAME: ______NAME: ______
POSITION: ______POSITION: ______

ADDRESS: ______ADDRESS: ______

______

______

Before signing this Form please ensure that you have replied fully to all questions. You should also satisfy yourself that you are eligible under the qualifications. Longford County Council cannot undertake to investigate the eligibility of Candidates in advance of the interview/examination, and hence persons who are ineligible but nevertheless submit an application put themselves to unnecessary expense.

I, the undersigned, HEREBY DECLARE all the foregoing particulars to be true and 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, agencies, Garda or organisations of such information as may be necessary to Longford County Council for that purpose. This may include enquiries from past/present employers and the submission of this application is taken as your consent to this.

Signed: ______Date: ______

Please give details of any specific requirements which you may require for interview arrangements.

______

Important General Information

Longford County Council reserve the right to shortlist candidates.

It should be clearly noted that canvassing on behalf of candidates will lead to their disqualification from the competition.

Any employment offered is dependent on the information given being true.

False or misleading information or deliberate omissions may result in termination of employment.

Expenses incurred by candidates in attending interview, etc., will be at the candidates own expense.

Longford County Council is committed to providing equality of opportunity in all employment practices.


Comhairle Chontae Longfoirt
Longford County Council
Aras an Chontae, Great Water Street, Longford.
Tel: (043) 3343304e-mail:

ACKNOWLEDGEMENT SHEET – POST OF RETAINED FIREFIGHTER

LANESBORO FIRE BRIGADE

If you wish to receive acknowledgement of your application within 7 days of postage, please complete this acknowledgement sheet. (Do not attach this sheet to your application form).

______Candidate Name (Please Fill in)

______Candidate Address (Please Fill in)

______

______

FOR HUMAN RESOURCES USE

(HR must retain a copy of this sheet with the candidates application form)

Human Resources Stamp

PLEASE NOTE
Longford County Council will acknowledge receipt of your application, if requested, within 7 days. If you do not hear from us within this time limit, please contact Human Resources Section at 043 – 3343304 or email /
FOR OFFICE USE ONLY
Acknowledgement Issued
Date …………………………
Signed ……………………….

POST OF RETAINED FIREFIGHTER, LANESBORO FIRE BRIGADE

MEDICAL HISTORY – AUTHORISATION FORM

I hereby authorise my doctor,

Address:

To supply details of my medical history to the Longford County Council’s Medical Advisor, Dr. P. McGarry, 1 Ballinalee Road, Longford. The information given by my doctor to be treated as strictly confidential.

Signed: ___ Date:

Please print name here: ______

RETAINED FIREFIGHTER LANESBORO

Document to confirm that you live within a 2 mile radius of the Fire Station.

I, wish to confirm that I live and work within a 2 mile radius of Lanesboro Fire Station. If at any time this condition is not fulfilled, I will be required to resign. The Chief Fire Officer must be notified of any change of address or employment.

Please tick (P) appropriate box:

I do live and work within a 2 mile radius of Lanesboro Fire Station 0

I do not live and work within a 2 mile radius of Lanesboro Fire Station 0

Signed: ___ Date:

Please print name here: ______

RETAINED FIREFIGHTER LANESBORO FIRE BRIGADE

Document to confirm that your employer is willing to release you to attend to the duty of

Retained Firefighter.

I, (employer) wish to confirm that I am willing to release Mr/Ms ______(employee name) to attend to the duty of Retained Firefighter.

Please tick (P) appropriate box:

I am willing to release the above named employee to attend the duty of Retained Firefighter 0

I am not willing to release the above named employee to attend the duty of Retained Firefighter 0

Signed: ______(Employer)

Please print name here: ______

Date: ______

Company Name: ______

To be completed by employee:

Should I be employed as Retained Fire-fighter and if at any time in the future, there is a change in my permission from my employer to attend to the duty of Retained Firefighter, I must notify the Chief Fire Officer of any change.

Signed: ______(Employee)

Please print name here: ______

Date: ______

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