Application form Water & Wastewater Caretaker Grade 3 for the position of:

This application form, when completed, should be e-mailed to [email protected] so as to arrive not later than Monday, 18th December 2017.

1. Forename: ______Surname: ______

2. Postal Address: ______

______

3. Telephone No.: ______

E-mail Address: ______

4. GENERAL EDUCATION:-

School or College From To Examinations Results Attended

5. ACADEMIC AND/OR PROFESSIONAL QUALIFICATIONS:-

*(must be completed)* Full Title of Degree(s) and Qual(s) held

Level of Qualification in the National Frame- work of Qualifications Type & Grade of Honours (1st or 2nd Class, Gr. I or II)

University, College or Examining Authority

Year Degree / Qual. Obtained

Subject(s) in final Exam 6. EMPLOYMENT RECORD:-

Give below, in date order, full particulars of all employment (including also any periods of unemployment) starting with your current position to the date of leaving school or college. No period between these dates should be left unaccounted. If it is necessary to continue on a separate sheet, please set out the information in the same manner as below.

*(must be completed)* Name & Address of Employer FROM TO Job Title

Description of duties/responsibilities:

Name & Address of Employer FROM TO Job Title

Description of duties/responsibilities:

Name & Address of Employer FROM TO Job Title

Description of duties/responsibilities: 7. Having regard to the requirements set out in the Briefing Document, please indicate below any particular skills and experience you have acquired which the Interview Board should be aware of. Please support your answer by examples from your work experience to date.

8. Give particulars of your knowledge of the Irish Language.

Oral______Written ______

9. Have you ever been convicted of a criminal offence? ______If so, please give details.

______

10. If offered appointment when could you take up duty? ______

11. Names and addresses of two responsible persons to whom you are well known but not related and to whom reference may be made as to character. (If you are or have been in employment, one of the referees should be your most recent employer):

Name: Name: ______Occupation: Occupation: ______Address: Address: ______

______E-mail: E-mail: ______Contact No: Contact No: ______12. We require the following information to enable us provide for any needs you may have, should you be called for any stage of this competition, e.g. sign language. If yes, please give details of your requirements, if any, to enable us to make appropriate arrangements for this competition:

______

______

13. Do you hold a current full driving licence and have access to your own car? YES  NO 

Indicate Class(es) of Driving Licence: ______

14. Before signing this form please ensure that you have replied fully to all questions. You should also satisfy yourself that you are eligible under the Qualifications. The Council cannot undertake to investigate the eligibility of candidates in advance of the interview/examination, and hence persons who are ineligible but nevertheless enter may thus put themselves to unnecessary expense.

An official application form must be completed in full by the closing date for the competition. Please note that amendments to the application form will not be accepted after the closing date.

I, the undersigned, hereby declare all the foregoing particulars to be true.

Signature: ______Date: ______