Employee Application Form

Please read all instructions, job description and person specification prior to completing this form.

Post Applied For:

Preferred Region:

Where/how did you hear about the vacancy? If you were referred please state who.

Preferred Employment:

Personal Details

Title:

First Name(s):

Surname:

Address:

Home Telephone Number:

Mobile Telephone Number:

Email:

Are you entitled to work in the Republic of Ireland?

Do you need a Visa to work in the Republic of Ireland? (Provide details):

Are you registered with CORU?:

If yes, please provide your CORU Registration number:

Have you been Garda vetted?

Have you resided in another country for more than 6 months, if YES please state country and date?

Do any of your family members currently work for Care Visions?

Do you hold a current full driving licence?

Does your licence have penalty points or endorsements?

If yes, please give details:

Education

Name of School Attended:

Date Attended:

Qualifications Gained At School (Subject, Grade):

Have you completed further education? YesNo

If yes, please provide details below:
(Name of College/University, Qualification: Diploma or Degree. List Post Graduate qualifications if any?)

Are you currently in full or part time education? YesNo

If yes, please provide details below:
(Name of College/University, Course Studying, Expected Date of Completion)

Membership of Professional Bodies

Are you currently a Member of any Professional Bodies? YesNo

If yes, please provide details below:
(Name of Awarding Body/Institution, Class of Membership, Date of Re-registration)

Employment

Present or Most Recent Employment

Company Name:

Full Address & Contact Details:

Job Title:

Date Started:

Date Left (if applicable):

Salary & Other Benefits:

Notice period:

Main Duties & Responsibilities:

Reasons For Leaving:

Referee
References must be from a person who has line-managed/supervised you. We do not accept character references or references from friends. References may be requested prior to interview, please indicate if you would prefer that we did not contact a referee prior to an interview being held.

Name:

Job Title:

Relationship to You:

Email:

Phone Number:

May we contact this person now?

YesNo

If no, please detail why:

Declaration IMPORTANT (Please read carefully before submitting)

Data Protection

In accordance with the General Data Protection Regulation, the information entered onto this form and any accompanying papers submitted along with it will be used to assess your suitability for the post and if successful, will be shared with recruitment managers for the purposes of interview and assessment for the role. Out with this process, the information will not be released to anyone who does not require it for this purpose. If you are employed the information you have provided on this form will be used for your human resources record and for payroll purposes.

If your application is not successful, or you withdraw after this stage, we can keep your details on file and consider you for any future vacancies. Please tick the box below as applicable:-

noneYES (I consent to Care Visions storing my information for six months after which point it will be securely destroyed)NO (I do not consent to Care Visions holding my information for future applications)

You can withdraw your consent at any time by emailing info@carevisions.ie

You have the right to require us to correct any inaccuracies in your information by emailing info@carevisions.ie

I certify that to the best of my knowledge all statements given by me on this form are true and accurate. I understand and accept that if it is subsequently discovered that any statement is false or misleading or that I have withheld information, my employment may be terminated without notice.

For more information on how we store and process your data, please read our Candidate Privacy Policy.