Church Street, Kilcock Co Kildare Phone: 01-6287258 Fax: 01-6284075 www.scoildara.ie [email protected] Scoil Dara APPLICATION For Official Use Only: FORM Called To Interview: Not Shortlisted: TITLE OF POST: PERSONAL DATA: Name: Address: Home Phone: Mobile Phone: Email: P.P.S. Number: QUALIFICATIONS: 1.1 2.1 Honours 2.2 Year of Award Pass Grade Awarded Award (Degree, Diploma, etc.) Awarding Authority Name of University,Training College, I.T., College of Technology, etc., attended. (a) (b) (c) Length of Course(s) (a) ______________ Subjects Taken in Course(s) and Examinations: (b) _____________ (c) __________ PRIMARY DEGREE First Year: (b) Second Year: (c) Other Year(s): Higher Diploma in Education/Post-Graduate: Teaching Council Registration Number: Indicate subjects which you are recognised by Teaching Council to teach: Grade Awarded 1.1 2.1 HONOURS 2.2 PASS Year of Award Part-time Other Qualifications Full-time Final Year: Awarding Authority TEACHING EXPERIENCE: From To Category (PWT, TWT, PRPT, PT) School Teaching Activity OTHER EMPLOYMENT: From To Employer Nature of Employment OTHER INFORMATION (Interests, etc.) – (You may use a separate sheet) NAMES AND ADDRESSES OF TWO REFEREES FROM WHOM REFERENCES MAY BE SOUGHT: NAME ADDRESS: PHONE NO NAME ADDRESS: PHONE NO MOBILE NO MOBILE NO If appointed, I can take up duty on _________________________(Date) DECLARATION:In applying for this Post,I declare that the particulars given are correct. SIGNATURE: _______________________________ DATE: Please note if you have any special requirements, contact the school office (016287258)) and we will endeavour to facilitate you. Scoil Dara is an equal opportunities employer APPLICANTS SHOULD NOTE THE FOLLOWING (a) Application form will be accepted up to closing date. It is the responsibility of the Applicant to ensure that either an electronic copy or a hard copy of this form reaches Scoil Dara before the closing date of 5pm on Fri 08 Aug 2014. Late Applications will NOT be considered. (b) Short-listing may apply and candidates must be available for interview on the date specified.