Candidate ID Number:NRS1077 -
All sections to be completed in full
APPLICATION FORM
CLINICAL NURSE MANAGER 1 (Coronary Care)CLINICAL NURSE MANAGER 1 (Dialysis)
NRS1077
Waterford Regional Hospital
Section A Please carefully note the following instructions:
· Please ensure you fully read and understand the “Additional Campaign Information for Candidates for the position of Clinical Nurse Manager 1 specific to this campaign that is available on http://www.hse.ie/eng/staff/jobs
· Please ensure you read the instructions for the completion of this application form and complete all areas, including the supplementary questions section, in full. Failure to complete all areas of the application form may result in you not being brought forward to the next stage of the selection process.
§ Please ensure that your completed Application Form reaches this office no later than 12:00 noon on Wednesday 12th February 2014. Applications received after this date and time will not be accepted. This closing date and time is strictly adhered to.
§ Candidates should note that there can be a time delay in receiving email applications. We recommend that applicants wishing to return an application by email should allow a minimum of 1 hour for their application to reach email inbox by the closing date and time of 12:00 noon on Wednesday 12th February 2014. Applications will not be accepted after this time.
§ In relation to details of employment, if the space provided is insufficient, please attach additional pages ensuring to use the same format.
§ Please read the Job Specification which provides useful information about the requirements of this post.
§ Should you be invited for interview, you may take a copy of your application form with you.
§ The Health Service Executive will run this campaign in compliance with the Code of Practice prepared by the Commissioners for Public Service Appointments (CPSA). Codes of practice are published by the CPSA and are available on http://www.hse.ie/eng/staff/jobs in the document posted with each vacancy entitled “Code of Practice, Information for Candidates’.
§ The Health Service Executive is an Equal Opportunities Employer.
§ The Health Service Executive recognises its responsibilities under the Data Protection Acts 2003 & 1988 and the Freedom of Information Acts 1997 & 2003.
Please return completed application form to:E-mail: Tel: 071 98 35291
Post: Elaine McLoone, National Recruitment Services, Health Business Services, Aras Slainte Chluainin, Manorhamilton, Co. Leitrim
Closing date for applications: / Wednesday 12th February 2014 at 12 noon
It is anticipated that interviews will be held : March 2014
Applicant Details:
Position Applied for: / Clinical Nurse Manager 1 (Coronary Care)and/or
Clinical Nurse Manager 1 (Dialysis)
Position Reference No.: / NRS1077 -
Candidate Reference No.: FOR OFFICE USE ONLY / NRS1077 -
Personal Details:
First Name :
Last Name:
Address for correspondence:
MOBILE TELEPHONE:(mandatory)
(max 1 number)
Contact Tel No. 2 :
E-mail Address :(mandatory)
(You may provide more than one):
Please provide current registration body eg. Nursing Midwifery Board of Ireland Registration/PIN number as appropriate :
Name of Division(s) currently registered in:
Registration/PIN Number:
Registration/PIN Expiry Date:
Where did you see this position advertised?
Drivers Licence (please state type & category):
European Economic Area
Are you an EEA (European Economic Area) National? Yes / No
Please see Appendix 2 of Additional Campaign Information for definition of an EEA National.
NB If you are a non EEA citizen you must provide the requested documentation to support your application. For further information you must read “Appendix 2” in the "Additional Campaign Information”
1. Superannuation Schemes
Are you currently in receipt of a pension from any of the following superannuation schemes?YES / NO
1. Local Government Superannuation Scheme (LGSS)
2. Health Service Executive Employee Superannuation Scheme
3. Voluntary Hospital’s Superannuation Scheme (VHSS)
4. Nominated Health Agencies Superannuation Scheme (NHASS)
If you have answered ‘yes’ in relation to any of the above Superannuation Schemes you are not eligible to apply for this recruitment campaign. Former Health Service and public sector employees must ensure that they adhere to their contractual obligations where they have previously availed of the Incentivised Scheme of Early Retirement (ISER), 2010 Voluntary Early Retirement Scheme (VER) or 2010 Voluntary Redundancy Scheme (VRS). Please read Appendix 5 in ‘Additional Campaign Information’ for further details.
2. Current Contractual Status
· I am currently a HSE employee* Yes No
If you answered yes to the above question, please choose the option below which best matches your current contractual status:
· I have a permanent contract
or
· I have a temporary contract
*HSE Employee = you are a direct employee of the HSE and not in a post funded or partially funded by the HSE
3. Proficiency in Irish
Candidates will be afforded the added opportunity to demonstrate their ability to perform the duties of the office through Irish. This assessment will be on a pass/fail basis and will not disturb the marks awarded in the selection process. Where vacancies arise for which proficiency in Irish is a management requirement, the HSE will offer such posts in order of merit to candidates who have successfully passed the Irish assessment. Please indicate if you wish to undertake an Irish assessment exam Yes / No
QUALIFICATIONS & ELIGIBILITY CRITERIA
Please indicate below how your qualifications meet the eligibility criteria for the post of Clinical Nurse Manager 1. Please note that if you omit information in this section pertinent to the eligibility criteria you will be deemed ineligible and subsequently not called forward to interview. (Please read Appendix 1 of Additional Campaign Information before completing this section.) Please complete each section below.
1. Registered in the General Division of the Register of Nurses kept by An Bord Altranais agus Cnáimhseachais na hÉireann (Nursing Midwifery Board Ireland)or be entitled to be so registered.
Registration / Pin NumberI am actively registered in the above marked division of the Register of Nurses kept by the Nursing Midwifery Board Ireland
I am on the inactive register in the above marked division of the Register of Nurses kept by the Nursing Midwifery Board Ireland
I am registered as marked above with a European Authority other than the Nursing Midwifery Board Ireland
I am registered as marked above with a non European Authority
The date my name was entered on the register for the above marked division is:
Please enter as DD/MM/YYYY
Seeking registration with Bord Altranais agus Cnáimhseachais na hÉireann (Nursing and Midwifery Board of Ireland) is the responsibility of the applicant. Please read Appendix 1 Additional Campaign Information for more information on registration.
2. I wish to apply for the role of:
Please tick the role(s) for which you wish to applyClinical Nurse Manager 1 (Coronary Care)
Clinical Nurse Manager 1 (Dialysis)
You may choose one/both roles. You are required to provide specific details to demonstrate your specialist experience in nursing care relevant to the post in Question 4a. (single Specialist Area choice) and/or Question 4b. (second Specialist Area choice).
2 (a). If you wish to apply for the Dialysis post please complete the section below:
Please indicate your 3 years post registration experience of which 1 year must be in the speciality or related area. Please note that you must have achieved the 3 years (36 Months) experience no later than 12th February 2014. Please detail below (in months) your experience to date that demonstrates your fulfilling of the above eligibility criteria. Please note that the information supplied here will be used to determine your eligibility for this campaign. If you work in a part-time capacity please list your monthly hours and total months of work as they are. Please do not make whole time equivalent calculations.
From Date 00/00/00 / To Date00/00/00 / Average Monthly Hours / Total Months / Employer / Title of Post
Total Cumulative Months
2 (b). If you wish to apply for the CCU post please complete the section below:
Please indicate your 3 years post registration experience of which 1 year must be in the speciality or related area. Please note that you must have achieved the 3 years (36 Months) experience no later than 12th February 2014. Please detail below (in months) your experience to date that demonstrates your fulfilling of the above eligibility criteria. Please note that the information supplied here will be used to determine your eligibility for this campaign. If you work in a part-time capacity please list your monthly hours and total months of work as they are. Please do not make whole time equivalent calculations.
From Date 00/00/00 / To Date00/00/00 / Average Monthly Hours / Total Months / Employer / Title of Post
Total Cumulative Months
EDUCATIONAL ACHIEVEMENTS
Please include second level and third level educational achievements:
DatesFrom / To / Educational Institution / Conferring
Body / Course of Study / Qualification Achieved / Grades Achieved
DETAILED CAREER HISTORY – listing the most recent first
From (00/00/0000) / To
(00/00/
0000) / Employer / Title of Post / Main Roles and Responsibilities
In the spaces below, briefly describe what you consider to be a good example of demonstrating your ability in each of the skill areas 1-3. A summary definition of each of skill areas is provided for your information. This is a summary of what we mean by each skill heading. Please provide the information in the format requested at (a), (b), and (c) on the “Information on completing the Supplementary Questions” Section. Remember anything you say may be evaluated for the purposes of a ranking exercise and/ or shortlisting and maybe discussed in more depth at interview if you are called to one.
1. Organisation & Management SkillsIt is important for the CNM 1 to be able to plan and organise resources efficiently and effectively within a specified timeframe. S/he co-ordinates and schedules activities to ensure the smooth running of his / her area of responsibility and will effectively manage unexpected events. S/he is flexible and adaptable in approach to their workload. In the space below, please give an example of a situation where you best demonstrated your ability in this area.
2. Building & Maintaining Relationships (including Team Skills & Leadership potential)
The effective CNM 1 will demonstrate good interpersonal skills and the ability to build and maintain relationships. S/he demonstrates the ability to work well as part of a wider team, being approachable, helpful and supportive. S/he uses diplomacy and tact in fraught situations and can diffuse tense situations comfortably. In the space below, please give an example of a situation where you best demonstrated your ability in this area.
3. Commitment to Providing a Quality Service
An effective Clinical Nurse Manager 1 demonstrates a commitment to providing a quality service. S/he is innovative and open to change in striving to ensure high standards in service delivery. S/he ensures that the service user is a key consideration at all times. S/he monitors and reviews his / her own work to ensure its quality and accuracy. In the space below, please give an example of a situation where you best demonstrated your ability in this area.
4. Experience Relevant To The Role:
Please provide below SPECIFIC DETAILS from your experience to date relevant to the post you have applied for that you feel help you meet the requirements for this post as detailed in the Job Specification. Please note the information you use below may be used for the short listing assessment. You may apply for more than one post and your experience for each post will be assessed in order to ensure it meets the criteria for that individual post. If you apply for more than one post you must complete the relevant sections below.
4 a) NRS1077 Clinical Nurse Manager 1 CCU
Please outline your depth and breadth of CCU nursing experience as relevant to the role.
Date(s) from – Date(s) to / Employer(s) & Department Name
4 b) NRS1077 Clinical Nurse Manager 1 Dialysis
Please outline your depth and breadth of Dialysis nursing experience as relevant to the role.
Date(s) from – Date(s) to / Employer(s) & Department Name
General Declaration
It is important that you read this Declaration carefully and then sign it in the space below.
Part 1: Obligations Placed on Candidates who participate in The Recruitment Process.
The Public Services Management (Recruitment and Selection) Act 2004 makes very specific provisions in relation to the responsibilities placed on candidates who participate in recruitment campaigns and these are detailed in Section 4 of the Code of Practice issued under the Act.
These obligations are as follows:
Any canvassing by or on behalf of candidates shall result in disqualification and exclusion from the recruitment process. Candidates shall not:
· knowingly or recklessly make a false or a misleading application
· knowingly or recklessly provide false information or documentation
· canvass any person with or without inducements
· personate a candidate at any stage of the process
· knowingly or maliciously obstruct or interfere with the recruitment process
· knowingly and without lawful authority take any action that could result in the compromising of any test material or of any evaluation of it
· interfere with or compromise the process in any way
Any person who contravenes the above provisions, or who assists another person in contravening the above provisions, shall be guilty of an offence.
It is the policy of the HSE to report any such above contraventions to An Garda Siochana.
In addition, where a person found guilty of an offence was or is a candidate at a recruitment / selection process, then, in accordance with the Public Services Management (Recruitment and Selection) Act 2004:
· where he / she has not been appointed to a post, he / shall be disqualified as a candidate; and
· where he / she has been appointed as a result of that process, he / she shall forfeit that appointment
Part 2
Declaration: “I declare that to the best of my knowledge and belief there is nothing in relation to my conduct, character or personal background of any nature that would adversely affect the position of trust in which I would be placed by virtue of my appointment to this position. I hereby confirm my irrevocable consent to the Health Service Executive to the making of such enquiries, as the Health Service Executive deems necessary in respect of my suitability for the post in respect of which this application is made.