Cork Centre for Independent Living Limited

Application Form

Post: Administration Officer

pleaseread carefully. complete all sections typed orblackink

Name: / PPS:
Address:
Phone No: / e-mail:
Have you ever been convicted of an offence? / Yes / No
Do you currently have Garda/ police Clearance? / Yes / No
Date & place of issue
This post requires the applicant to undergo Garda Vetting.
If shortlisted for interview you will be required to complete the Garda Vetting Form.
Do you require a permit to work in the State? / Yes / No
Where did you hear of Cork CIL?

Education (school, college, university -most recent first) – Include all major awards including professional training

Qualification / Institution: / Year

Short Courses / Training - please write N/A if

Qualifications: MOST RECENT FIRST
e.g. Manual Handling, ECDL etc. / Institution/ Trainer / Year

Employment - (start with the most recent). If you have relevant work experience include it here.

Employer / Role & Responsibilities / From
Date / To
Date

Health/illness: please provide details of any illness/accident in the past three years that has kept you away from work

Number of days Number of episodes

Please give any further information that will support your application (continue a separate sheetif required):

______

Signed:Date://

References:

A minimum of 3 references are required. One should be your current or last employer

Name:

Position:Contact No:

Address:E - Mail

Name:

Position:Contact No:

Address:E - Mail

Name:

Position:Contact No:

Address:E - Mail

Referees will not be contacted without your prior consent. If you are shortlisted you will be contacted and asked to secure your references

I declare that all information given by me is correct.

Signature: ______Date: ______

Print name: ______

PLEASE SEND YOUR COMPLETED APPLICATION TO or post to

Cork CIL First Floor Lawley House Monahan Rd Cork

Data Protection and Freedom of Information

The Cork Centre for Independent Living, will treat all information and personal data you give as confidential. We will only disclose it to other people or bodies in line with law. We are responsible for it under the Data Protection Act and Freedom of Information Act.

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