APPLICATION FORM

Please complete all sections accurately, giving as many details as possible of your skills and experience in relation to this job application. Shortlisting will be based on the information gathered from the form.

Application is by way of this application form only – CVs will not be accepted.

Please return your completed application to:

Please type directly in this form.

POSITION APPLIED FOR
Job Title:
Location:
Where did you hear about this vacancy?(please indicate specific website if seen online)
1. APPLICANT DETAILS
Title / First Name / Surname
Contact Details
Home phone:
Mobile :
Email Address:
Home Address:
Further Details
Do you have a clean drivers licence?
Do you have permission to work in Ireland?
2. EDUCATION AND QUALIFICATIONS
Academic Qualifications
Awarding Body / Course /Subject / Grade Achieved / Date Awarded
Membership of Professional Body /Institute
Awarding Body / Level of Membership / Date Awarded
Additional Training/Educational Qualifications
Course Name / Level Achieved / Date Awarded

If you are applying for a clinical role please fill out the following:

Are you registered with CORU?
If yes, please state number
Are you registered with An Bord Altranais?
If yes, please state number
If your qualification is from overseas has it been validated in Ireland?
3. EMPLOYMENT HISTORY
3.a Please provide details of your most recent/current employment here.
Date (from -to) / Employer's name and address / Job title / Nature of employment (e.g. full-time, part-time including whole time equivalent, employment scheme, internship) / Duties and Responsibilities / Reason for Leaving
Current/most recent salary:
State notice period required:

3.b Please list all previous employment history (starting with most recent, prior to current)

Date (from -to) / Employer's name and address / Job title / Nature of employment (e.g. full-time, part-time, employment scheme, internship) / Duties and Responsibilities / Reason for Leaving

3.c Please list any relevant volunteering experience you might have. (Max 400 words)

4. KNOWLEDGE AND SKILLS
Please refer to the job description when completing this section. The information you provide in this section will be used in assessing your application.
4a. Please outline with examples how your skills, knowledge and experience meet the criteria for this position and address the primary responsibilities of the role. (Max 400 words)

4b. Please state your reasons for applying for this position and the qualities you will bring to the role. (Max 400 words)

7. DECLARATION AND FURTHER INFORMATION

I understand and agree to the following:

Canvassing will result in immediate disqualification.

Should the employer hire me and should any of the information I have given in this application be false, misleading or incomplete, it may lead to my employment being terminated.

The employer reserves the right to interview only on the basis of information supplied on the application form by candidates who meet the criteria for the post.

Jigsaw is an equal opportunities employer, committed to ensuring that the talents and resources of all our employees are utilised to the full. We will not discriminate unfairly against any individual in matters of recruitment or selection for any position, promotion, training or development irrespective of; gender, civil status, race, ethnicity or colour, disability, religious or political opinion, sexual orientation, nationality or age.

I declare to the best of my knowledge and belief the information supplied on this form is accurate, complete and true.

______

Signature of ApplicantDate

Applications are by email only. Please return your completed application to:

“All application forms received by Jigsaw will be processed in accordance with the Data Protection Acts, 1988 and 2003. The information will only be used by Jigsaw in the processing of job applications and for ongoing administrative purposes with job candidates”.

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