APPLICATION FORM

Physiotherapist Basic Grade

Permanent
Our Lady’s Hospital, Navan
Campaign reference No: OLH2022/18

Thank you for applying to the HSE. Please read the Job Specification which provides useful information about the
requirements of this role.

Closing Date & Time 17.00 Friday 25th February 2022

Please complete application form and submit through our Rezoomo

recruitment page.
Any queries please contact 046 9078527
Return Application Forms To
CV’s will not be accepted

Campaign reference: OLH2022/18

Anticipated Interview Date(s) Immediate following the closing date

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 APPLICANT DETAILS

First Name:
Last Name:

Address:

Contact Telephone:

Email Address:

Eligibility to work in Ireland:

Are you eligible to work in the Republic of Ireland? Yes □ No □

Enclose a copy of your Valid Work Visa/Permit (if applicable)

Expiry Date of Visa/Permit:

ELIGIBILITY AND POST SPECFIC CRITERIA

The Job Specification has listed the following eligibility and post specific criteria for this application. Please
indicate below by tick box if you meet the criteria. Kindly note that the information provided in this application
form will be used for shortlisting purposes for this position. Please indicate below by tick box if you meet the
criteria.

Yes No

a) Candidates for appointment must:

(i) Hold a Physiotherapy qualification recognised by the Physiotherapists
Registration Board at CORU. Please see list of acceptable Physiotherapy
qualifications:
http://coru.ie/uploads/documents/Physiotherapist_Qualifications_HSE_List.pdf
AND
(ii) Be registered on the Physiotherapists Register maintained by the
Physiotherapists Registration Board at CORU.
OR
(iii) Applicants who satisfy the conditions set out in Section 91 of the Health and
Social Care Professionals Act 2005, (see note 1 below*), must submit proof
of application for registration with the Physiotherapists Registration Board at
CORU. The acceptable proof is correspondence from the Physiotherapists
Registration Board at CORU confirming their application for registration as a
Section 91 applicant.
AND
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 (b) Have the requisite knowledge and ability (including a high standard of
suitability and professional ability) for the proper discharge of the duties of the
office.

One year experience in a Healthcare setting is desirable but not essential.

EDUCATIONAL ACHIEVEMENTS

Please list your educational achievements to date:

Dates Educational Conferring Course of Study Qualification Grades

Institution Body Achieved Achieved
From/To

Additional training relevant to the role (including employment based training)

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 CAREER OVERVIEW
Please ensure your full career history is clearly outlined below and demonstrate (by bullet point) the roles and
responsibilities that are particularly relevant to the role and job specification to which you are now applying (also include
any time spent out of work e.g. career break). Kindly note that the information provided in this application form will
be used for shortlisting purposes for this position. Please begin by listing the most recent first.

Job Title:
Grade:

Employer(s) & Department Name:

From (00/00): To(00/00):

Main Roles & Responsibilities:

Job Title:
Grade:

Employer(s) & Department Name:

From (00/00): To(00/00):

Main Roles & Responsibilities:

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Job Title:
Grade:

Employer(s) & Department Name:

From (00/00): To(00/00):

Main Roles & Responsibilities:

Job Title:
Grade:

Employer(s) & Department Name:

From (00/00): To(00/00):

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 Competency Questions
As part of the interview process competency based questions will be asked. The competencies that will be discussed are
listed below. As part of your interview preparation please ensure you have reflected on examples of how you have
demonstrated your ability in each of the competency and skill areas and are prepared to discuss this in more depth at
interview. Please reference the job specification for a summary definition of each competency/skill area.

1. Knowledge and experience relevant to the role

2. Team working

3. Attention to detail

4. Flexibility and Adaptability

REFERENCES
References

We are required to seek the name, address, email address and occupation of three referees including your current
manager should a successful outcome following interview be confirmed.

I hereby give my permission to contact referees following submission of their details? Yes / No

General Declaration
It is important that you read this Declaration carefully and then sign it in the space below.

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.

I hereby accept and confirm the entitlement of the Health Service Executive to reject my application or terminate my
employment (in the event of a contract of employment having been entered into) if I have omitted to furnish the Health
Service Executive with any information relevant to my application or to my continued employment with the Health
Service Executive or where I have made any false statement or misrepresentation relevant to this application or my
continuing employment with the Health Service Executive.

Furthermore, I hereby declare that all the particulars furnished in connection with this application are true, and that I
am aware of the qualifications and particulars for this position. I understand that I may be required to submit
documentary evidence in support of any particulars given by me on my Application Form. I understand that any false
or misleading information submitted by me will render me liable to automatic disqualification or render me liable to
dismissal, if employed.”

Signed:

(Name of Applicant)

Date: