SCOIL POBAIL NA MAIGHNE
MoyneCommunitySchool
Moyne
Co Longford
049 4335114 (Tel)
049 4335802 (Fax)
Secretary Board of Management/Principal: Mr Des Cullen
For Official Use OnlyDate Received
Date of Interview
Time of Interview
Position for which you are applying
Personal Details
Name
Address
Tel: / Mobile: / E-mail:
P.P.S. Number
Present Position
Name of Employer
Qualifications
Primary Degree
Title of Qualification
Level of Award
University/Institute/College
Year Awarded
Duration of Degree course
Degree Subject (final year)
1st Year Subjects
Post Graduate Degrees
Title of Qualification
Level of Award
University/Institute/College
Duration of Degree course
Subjects Studied
Year Awarded
PGDE / Higher Diploma in Education
Level of Award
Year Awarded
University/Institute/College
Subjects Studied
Other Third Level Qualifications
Title of Qualification
Awarding Body
Year of Award
Subjects Studied
Qualifications in Irish
Teaching Council Registration
Are you registered with the Teaching Council (Please Tick Appropriate Box) / Yes / No / Pending
Please indicate your Registration Number /
Indicate subjects you are recognized to teach
Are you a member of a Subject Association
Please attach copy of current Teaching Council Registration and subjects recognized to teach
Employment Record
Name of Education Authority/Body by which employed / From / To / Capacity
- Part time
- TWT
- RPT
- Permanent
State subjects taught during the above employment(s) including the courses and levels
Posts of Responsibility (if held)
Duties of Post
:
List in-service courses taken (with dates), including the length of these courses and, where appropriate, the certification obtainedCourse Title / Location / Date
Other Relevant Experience/Employment
From / To / Employer / Nature of Employment
Other Interests
Extra Curricular activities in which you have and/or would be prepared to be involved
Any other relevant information
A separate sheet may be attached to record additional information
Please provide names, addresses and position/occupation of two people (other than relatives or friends) with knowledge of you and your work from whom a professional reference can be sought. One should be your current or most recent employer. Please note: your referees may be contacted without further communication with you and prior to selection interview if shortlisted for interview.
Please also attach two written references.
Name / Telephone
Address
Name / Telephone
Address
PERSONAL DISCLOSURE/GARDA VETTING
Have you been vetted via the Garda Central Vetting Unit? Yes No
Please attach copy of your Garda Vetting Clearance letter
Moyne Community School is obliged to ascertain that no employee poses a threat to students or staff. Moyne Community School must, therefore, ask the following questions at recruitment stage:
Have you ever been convicted of a criminal offence and/or an offence related to Child Welfare?
YES NO
Have you ever been the subject of an inquiry of investigation by the HSE/An Gardaí concerning a child welfare matter, or an investigation arising from a complaint/allegation of child abuse or wrongdoing towards a minor?
YES NO
- Please sign the form below, certifying that all information you have provided is accurate.
- The Committee may wish to check any of the details you have provided
- Providing incorrect information or deliberately concealing any relevant facts may result in disqualification from the selection process or, where discovery is made after an appointment, in summary dismissal.
Signed / Date
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Moyne Community School - Application for Teaching Post