Application Form

Institute of Technology Blanchardstown

Institiúid Teicneolaíochta Baile Bhlainséir

Application form – Guidelines

Completing the application form

1. Applications must be submitted using the Institute’s application form.

The application form must be type written and all sections completed

in full. Supplementary documentation e.g CV, is not required and will

not be considered as part of the application.

2. If applying for more than one post, a separate application form must

be completed. Full and accurate information should be provided as

the information may be used to shortlist candidates for interview.

3. Candidates may be required to provide documentary evidence to

support any statement made on the application form.

4. Where academic achievements and/or specific work experience are

required for a post, they must be achieved by the latest date for

receipt of applications. Degrees or other higher education

qualifications are reckoned only from the date of conferral.

5. Applications will be treated in complete confidence.

6. Applicants are asked to provide contact details for three referees, one

of whom should be a current or most recent employer. Permission

to contact referees and to seek attendance records from them will be

assumed unless otherwise stated on the application form.

7. Postal and email applications will be accepted, to

or FAO: Emer Melvin, ITB HR Department, Blanchardstown Road North, Blanchardstown, Dublin 15

Postal applications should be returned to the Institute of Technology Blanchardstown, HR Department, Block A, Blanchardstown Road North, Blanchardstown, Dublin 15. NB One original and 3 copies of the application form are required.

Please submit all applications on or before 5 pm on Friday 25th October, 2013. Late applications will not be accepted

Note: Canvassing will disqualify applications

Institute of Technology Blanchardstown

Institiúid Teicneolaíochta Baile Bhlainséir

APPLICATION FORM –

Specific post applied for / Student Support Services - Tutor Panel
Reference Number / P13/29
General Information
Surname
First name
Permanent address
Address for correspondence if different
Telephone number / Home: ____________
Work: ______
Mobile: ______
Email
Are you an Irish/EU citizen? / Yes No
If you are not an Irish/EUcitizen, do you have a current work permit for the Republic of Ireland? / Yes No
Have you ever been convicted of any offence by a Court in Ireland or abroad?
If yes, please furnish full details of the offence in question, the Court, the date of the conviction and the penalty or sanction imposed. / Yes No
EDUCATION
Institutions(s) attended / From / To / Certificates awarded, subjects and grades
Academic Qualifications
Award / Awarding Body / Conferral date / Grades / Final Examination subjects & results
Other Qualifications, including Membership/Fellowships
Organisation / Category of
membership – full,
associate, student, etc / Date of award
dd/mm/yy / Indicate how membership was achieved
Current Employment
Employer’s name or title
Employer’s address
Nature of business
Employment Period
Position in organisation
Functions & Responsibilities
Prior employments
Employer / From / To / Position and Function / Reason for leaving
Details of other previous experience relevant to application.
This section should include a description of experience relevant to the criteria outlined in the job description.
Details of current remuneration package
Current Salary
Salary Scale / Point on Salary Scale: -
Allowances
Other benefits
Reason for seeking the position applied for
Period of Notice
How soon would you be available to take up the position if it were offered?
Additional information – any other information that may help in assessing your application.
Advertisement - how did you become aware of the position advertised?
ITB website □ / Word of mouth □ Other □
Referees – the Institute will assume permission to contact referees to seek references and attendance records unless the applicant has stated otherwise. Please include current or most recent employer.
Name and address / Position / Contact
1st Referee / Ph:
Mobile:
E-mail:
2nd Referee / Ph:
Mobile:
E-mail:
Declaration
I hereby certify that I have read the Notes on Page 1 of this application form and that all statements given by me on this application form are true complete and correct.
Signature of applicant
/ ______
Date
/
______

Application Form