DE LA SALLE DUNDALK
ROLL NO.63891T
APPLICANT’S PERSONAL DETAILS
Name
Please Indicate Post Applying For
Correspondence Address
Mobile
Landline
E-mail
Date of Birth
QUALIFICATION TO TEACH
Qualification(s)
Overall
Grade
Teaching
Practice Grade
Awarding University/College
Year of Award
TEACHING COUNCIL REGISTRATION
Registration Number ________________________
Registration Status:
Full
__
Conditional
Pending: If pending, please state the date of submission of application: _________________
Subjects you are registered to teach: __________________________________________________________
National Vetting Bureau
Full
Conditional
All appointments are subject to satisfactory Garda Vetting and the terms of the National Vetting Bureau(Children and
Vulnerable Persons Acts 2012 – 2016) The position is subject to the approval of the DES and to the post not being required
for the Redeployment Process.
1
DE LA SALLE DUNDALK
ROLL NO.63891T
ACADEMIC QUALIFICATIONS – MOST RECENT FIRST
Qualification & Grade
Awarding University, College
or Institute
Length of Course
Year of Award
TEACHING EXPERIENCE – MOST RECENT FIRST
School Name & Address
Date(s) of service in
the school
Position(s) held
Dates in each Position
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
POST(S) OF RESPONSIBILITY HELD (IF ANY) – MOST RECENT FIRST
School Name
Address
Position(s) held
Dates
From:
To:
From:
To:
2
DE LA SALLE DUNDALK
ROLL NO.63891T
*IF NEWLY QUALIFIED PLEASE INSERT TEACHING PRACTICE PLACEMENTS – MOST RECENT FIRST
School Name
Address
Subject taught
Dates
From:
To:
Years taught
From:
To:
From:
To:
From:
To:
ADDITIONAL QUALIFICATIONS E.G. ICT (IF APPLICABLE)
College(s)
Qualification and Year
OTHER RELEVANT COURSES – MOST RECENT FIRST
3
Modules Studied
DE LA SALLE DUNDALK
ROLL NO.63891T
AREAS OF SPECIAL INTEREST – CURRICULAR/EXTRA CURRICULAR/OTHER
Area
Expertise/Experience
OTHER RELEVANT EMPLOYMENT EXPERIENCE – MOST RECENT FIRST
Employer
Position
Duties
Dates
From:
To:
From:
To:
From:
To:
From:
To:
PLEASE INDICATE HOW YOU THINK YOUR EXPERIENCE CAN ASSIST IN THIS PARTICULAR POST
NOT MORE THAN 150 WORDS
4
DE LA SALLE DUNDALK
ROLL NO.63891T
PLEASE INDICATE HOW YOU THINK YOU CAN CONTRIBUTE TO THE ETHOS AND SUCCESS OF DE LA SALLE COLLEGE
NOT MORE THAN 150 WORDS
ADDITIONAL INFORMATION (NOT ALREADY MENTIONED) TO SUPPORT YOUR APPLICATION
NOT MORE THAN 150 WORDS
5
DE LA SALLE DUNDALK
ROLL NO.63891T
NAMES & CONTACT DETAILS OF REFEREES*
Referee 1
Referee 2
Name
Name
Position
Address
Position
Address
Work Tel
Number
Work Tel
Number
Home Tel
Number
Home Tel
Number
Mobile No
Mobile No
Referee 3
Referee 4
Name
Name
Position
Position
Address
Address
Work Tel
Number
Work Tel
Number
Home Tel
Number
Home Tel
Number
Mobile No
Mobile No
*Please Note:
1. Only those referees who know you in a professional capacity should be included. A minimum of 2 referees
should be listed.
2. If the current employer (where applicable) is not named as a referee, the Selection Board reserves the right
to seek a reference from the current employer.
3. The Selection Board in its sole discretion will determine the suitability of any reference. The Selection Board
further reserves the right to seek from a candidate the names of additional referees.
4. Shortlisting may apply.
I hereby declare that all the particulars furnished on this application form are true and correct to the best of
my knowledge and that I am aware of the qualifications, requirements and particulars for this post, as set
out in the advertisement and other relevant documentation.
Signature ____________________________
Date _____________________
Applications should be forwarded to [email protected]
6