Application Form

Personal Details

PPS Number / National Insurance Number*
Address Line two
State / Province / Region
Post Code
Previous Surname (if any)
Phone Number*

Next of Kin

Next of Kin name*
Relationship *
Phone Number *
Next of Kin Address *
Address (line two)
State / Province / Region
Post Code

The Position

What role are you applying for? *
Please state details of any special arrangements you require to facilitate the interview process:


Do you hold a current, full, clean, manual Irish or UK driving licence? *
What date did you gain this licence?
Do you have any driving convictions or endorsements? *
Please provide details:

Education / Qualifications

University/Further Education:
Please record the following details: - Institution(s) Attended / Year(s) Attended / Qualification(s) Obtained / Grade(s) Achieved.


Please provide details of three referees, the first of whom must be your present or most recent employer. Remaining referees must know you in an Employment, Voluntary or Academic capacity. Relatives must not be named as referees.

Referee 1

Referee 2

Referee 3


Please outline below all your relevant skills and training including details of the subject/area, level attained, date completed and expiration date (if applicable):

Previous Employment

Please provide details of all the posts you have held, including relevant student placements and/or voluntary work with young people, accounting for any gaps in your employment and whether it was full time or part time. You must also provide details of all education, employment or travel that took place for a period of 3 months or more outside of Ireland. NB: You must provide full details from the date that you left secondary school. Please begin with the most recent post.

State Role, Company, Main Duties, Dates of Employment, reason for leaving and whether role was full time or part time. If part time role please state hours/week worked:*

I confirm that I have provided full information of all education, employment and travel that has occurred from the year of finishing school to date.

Please tick here to confirm:

Details of Present/Most Recent Employment

Job title *
Employer Name and Address *
Date Employment Started *
Notice Required: *

Supplemental Information

Please provide any additional information you would like to add to support your application:


Please provide details of any absences from work due to illness over the last three years including reason and dates:

You will be asked to complete a short medical questionnaire prior to taking up post and in some instances at Ashdale Care's discretion, a pre-employment medical check may be required. On these occasions we will refer you to the company doctor.

Garda/Police Clearance

Applicants must complete the following in full:

Do you consent to Ashdale Care carrying out a Garda/Police check? *
Do you have any previous/pending convictions, cautions, bind-overs etc.? *
Are you prepared to discuss all relevant convictions, cautions, bind-overs etc. openly with the panel if selected for interview? *
YesNoI do not have any

Lastly, where did you hear about us? *

I declare that the information I have given above is true and correct and know of no reason why I would be unsuitable to work with children and/or young people. If it is subsequently discovered that I have failed to declare convictions, I understand that I may be excluded from the rest of the selection process and any offer of employment may be withdrawn.
I accept *
Enter your initials *
Data Protection Statement
Access to the information on this form will be restricted to a limited number of authorised staff within Ashdale Care Ireland Ltd.

The details on this application form will be used to ascertain your suitability for the role you have applied for. Only the information contained on this application form can be considered by the shortlisting panel. You should therefore ensure that you demonstrate clearly how you meet each element of the essential criteria as outlined within this form.

The information may be used for the purposes of compiling employee statistics and equal opportunities monitoring.

The Information may be accessed by a third party to ensure you meet the required standards set for this sector.

I give consent to this information being processed and stored (by means of a computer database or otherwise) as described above, for the duration of my contract of employment and to fulfil the statutory or recommended, retention periods when I am no longer an employee with Ashdale Care Ireland Ltd.

I confirm that all the information given on this form is complete and correct by ticking the box you confirm your agreement to this Data Protection Statement

I accept *
Enter your initials *

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