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


    Phone Number

    Next of Kin Address

    Address (line two)


    State / Province / Region

    Post Code


    The Position

    What role are you applying for?

    Location 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. We will obtain written and verbal references from those nominated.

    Referee 1

    Referee 2

    Referee 3

    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:


    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.

    Employment Gaps

    Please provide details of any employment gaps:

    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

    Do you know of any reason why you cannot work in a regulated activity?

    Work Visa

    Do you have a right to work/visa to reside and work in Ireland?

    Lastly, where did you hear about us?

    If 'Other' please give details.

    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 Limited who shall be the data controller in relation to this information.

    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. We may also obtain written and/or verbal references in relation to your previous employment or academic history in order to determine your suitability for the role.
    The information may also be used for the purposes of compiling employee statistics and equal opportunities monitoring.

    The legal basis on which we process your personal data in the manner described above is (i) subject to your consent (which can be withdrawn at any time), (ii) we are legally required by social protection law to obtain certain information from candidates who will be working with children, (iii) it is necessary to protect the vital interests of the children in our care and (iv) our legitimate interests in conducting our business in a responsible and prudent manner. The provision of your data is necessary in order to (if successful) enter into an employment contract with us. Failure to provide the required data will mean that we will not be able to enter into an employment contract with you. We will not process your personal data for these purposes if to do so would constitute an unwarranted interference with your own interests, rights and freedoms.

    For further information, please see our Privacy Statement

    I hereby give my consent to this information being transferred between the EU and Northern Ireland to be 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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