Application for Employment [Confidential]

NOTE: Before you start filling in the form, please make sure you have SAVED THE FORM TO YOUR OWN COMPUTER
(using Save AS from the ‘File’ menu). If you do not save a copy to your computer, you may lose all of the information in the
document.

POSITION APPLIED FOR AND LOCATION

Position: Location:

1. PERSONAL INFORMATION
(a) Surname (Second or Family name) (b) Forenames (First Name)

(c) Home Address Home Telephone No:

Mobile:
E-mail Address:
Work Telephone No:
May we, with discretion,
telephone you at work?
(d) In order to comply with the Employments Permits Acts 2003 & 2006, please give details of the basis which permits
you to be employed in the Republic of Ireland.

If successful documentation will be requested to confirm above.

All successful candidates will be asked to supply proof of identity and other appropriate documentation.

2. EDUCATION: Please give particulars under the following headings. The successful Candidate will
be required to supply verification of qualifications.
Name of College From: Full time or Details of Qualification:
To: Part time Diploma/Degree etc.
Second Level:

Third Level:

Post Graduate:

Other:
 3. EMPLOYMENT RECORD: Please give details of your complete working history beginning with your present or most recent employment
Dates employed Employer’s name, Job Title and description of duties Full or Part Final Salary Reason for
(Month and Year time
address and nature
Including leaving
MUST be of business
number of
specified) hours
From: To:
 3. (contd.) EMPLOYMENT RECORD: Please give details of your complete working history beginning with your present or most recent employment
Dates employed Employer’s name, Job Title and description of duties Full or Part Final Salary Reason for
(please specify month time
and year mm/yyyy)
address and nature
Including leaving
of business
number of
hours
From: To:
4. DISCLOSURE OF CONVICTIONS
(a) Has any action been taken against you or have you been subject of an investigation in regard to a
child/ children under the age of 18? Yes No

(b) Are you at present the subject of criminal charges or investigation? Yes No

(c) Is there anything in your background that would render you unsuitable to
work with children or in a child welfare organisation? Yes No

IF THE ANSWER IS ‘YES’ TO ANY OF THE ABOVE QUESTIONS, PLEASE GIVE DETAILS.

The successful candidate may be required to complete the E-vetting process and obtain other overseas police records if applicable
as part of our Recruitment process. A criminal record will not necessarily bar you from obtaining this position.

5. PLEASE STATE YOUR REASON FOR APPLYING FOR THIS POSITION

6. SOURCE OF APPLICATION 7. IF APPOINTED

How did you hear of this vacancy? When could you commence employment?
Please state Yes or No
Barnardos Website

Other Website

Newspaper

Word of mouth

Other
Please state details of other
8. INTERESTS AND VOLUNTARY ACTIVITIES
Please give brief details of pastimes, hobbies, sports, and any voluntary work undertaken.
 If you have not done so by now, please SAVE
THIS FORM TO YOUR OWN COMPUTER
(using Save AS from the ‘File’ menu).
If you do not save a copy to your computer, you
may lose all of the information in the document.

9. REFERENCES
Name, address and telephone number, of your present employer, or if unemployed, those of your last employer. If you have been in
your present employment for less than 2 years, please include your previous employer as an additional referee below.

Do you give us permission to write to your present/last employer without writing to you again? Yes No

Please give the names and addresses of two people whom we may contact without further permission for a confidential assessment
of your suitability for this job, preferably two previous employers. If this is a first job application, some other appropriate person
unrelated to you, e.g. your principal or college tutor. You should not give your own doctor as a referee.
1. 2.
Name Name

Address Address

Telephone Number Telephone Number

Occupation Occupation

How long acquainted How long acquainted

with you? with you?
In what connection? In what connection?

You are invited to include on a separate sheet any relevant supplementary information in support of your application.

10. CONDITIONS OF EMPLOYMENT

All offers of employment are conditional on satisfactory references, Medical Approval & Garda Vetting.
11. DECLARATION
I hereby declare that the above statements are true to the best of my knowledge. I understand that any deliberate mis-statement
may render me liable to dismissal, if employed. I further declare there is no known reason or event that would render me unsuitable
for the post or to work in a child welfare organisation.

Print Name: Date:

Signature:* Date:

*Shortlisted candidates are required to sign their application form at interview if they have not already done so.

Barnardos Application form August 2018 [Page 5 of 5]