2017 World University Games Application Form
Medical Personnel
Irish Sport HQ, National Sports Campus, Blanchardstown, Dublin 15, Ireland.
353 1 6251173 | [email protected] | studentsport.ie
2017 World University Games
Medical Personnel Application Form
Please Note:
1. To ensure that the information you provide below is accurately recorded we request that this
application form is typed and completed in full
2. The information given below must be accurate to the best of your knowledge at the date of signing.
Should your information change, please inform the Student Sport Ireland office immediately
3. Please note that if your application is successful, for accreditation purposes, relevant personal and
contact details provided below will be submitted to the 2017 World University Games Organising
Committee via an online portal. By applying for the role you are consenting to the transfer of these
relevant details to the OC
4. In applying for the role you confirm your availability travel to the World University Games in August
2017. If you require authorisation from your place to be available to travel in August 2017 we kindly
request that you obtain the appropriate authorisation BEFORE submitting your application.
5. To apply for this role please submit via email ([email protected]) the following documentation:
a.
b.
c.
d.
This application form (completed in full)
An updated CV
A copy of your passport page
A passport style photo (mobile head pic will suffice)
SECTION A: Please Indicate by an ‘X’ the Role You Wish to Apply For
(Applicants can apply for one or more roles as appropriate)
Team Doctor
Head Physiotherapist
Physiotherapist
Physical Therapist
SECTION B – Personal Details
Organisation:
Position:
Surname:
First Name:
Title:
Date of Birth:
Nationality:
Postal Address:
Home County
Mobile No:
Email Address:
/
/
In Case of Emergency:
Contact Name:
Relationship:
Contact Tel No:
Contact Mobile No:
SECTION C – Passport Details
Passport No:
Issuance Date:
Passport Expiry Date:
Issuing Authority:
SECTION D – Experience and Qualifications.
Please do not complete this section but submit an up to date CV separately with this application form.
SECTION E – Declaration
I wish to be considered for the above role. I have reviewed the job description(s) accompanying the role(s)
and I believe that I have the relevant experience and qualifications to undertake the role(s).
Applicant Name
Signature
Date
Please Complete Section F Overleaf
SECTION F – Gear Sizes
Please tick relevant sizes.
Garment Size
Chest
Waist
Polo
T-Shirt
Windcheater
Track Top
Track Pants
Gym Shorts
Football Shorts
Cargo Shorts
6
30”
24”
Female Sizes
8
10
32”
34”
26”
30”
12
36”
30”
14
38”
32”
16
40”
34”
18
42”
36”
XL
44”
38”
32”
2XL
46”
40”
33”
Female Inside Leg Length
28”
Short
30”
Regular
32”
Long
34”
X Long
36”
XX Long
Garment Size
Chest
Waist
Inside Leg –
Standard
Polo
T-Shirt
Windcheater
Track Top
Track Pants
Gym Shorts
Football Shorts
Cargo Shorts
XXS
34”
28”
29”
XS
36”
30”
30”
Male Sizes
S
M
38”
40”
32”
34”
32”
32”
L
42”
36”
32”
Please submit your Application Form in confidence to:
[email protected]
3XL
48”
42”
33”