All information provided in this form is confidential to the Selection Board (This form should be typed or completed using

block capitals in black ink) POST OF SPECIAL NEEDS ASSISTANT - APPLICATION FORM

School: ________________________________________________________ (If completing this form by hand, please use a ballpoint pen or black ink) Applicants Name

Completed and Signed Application Forms should be returned

! post to:

The Chai"pe"son #oa"$ o% Mana&ement (Refer to advertisement for address)

to arrive by '()* p(m( on Closin& Date( (refer to advertisement for closing date). lease !" #"T send a Curriculum $itae %ith this form& recruitment process& This may be re'uested later in the

lease !" #"T enclose any certificates %ith this form& (inimum educational re'uirements for this post are )nter Cert or *unior Cert or e'uivalent 'ualification+s& The successful candidate may be re'uired to supply original documentation in relation to other 'ualifications to the Board of (anagement prior to appointment& Fo" O%%icial +se Onl! ,eceived: !ate: Time:

All information provided in this form is confidential to the Selection Board (This form should be typed or completed using block capitals in black ink) PERSONAL DETAILS : , Name

-ome A$$"ess

-ome Tel( No( Mo ile Phone No( E-Mail A$$"ess

E$/cational 0/ali%ications 1 most "ecent %i"st (Include second level e.g. Inter Cert, Junior Cert or equivalent and further education (though not a requirement for this particular post). successful applicant may be requested to furnish supporting documentation. 0/ali%ication School2Colle&e Res/lts 3ea" o% A4a"$

Othe" "ele5ant6 non-acc"e$ite$ co/"ses 1 most "ecent %i"st: 7e(&( Fi"st Ai$6 A"t2C"a%t8(9

E;pe"ience o% Special Nee$s Assistant "ole - most "ecent %i"st & School Name A$$"ess D/ties Date %"om Date to

'

Othe" emplo!ment e;pe"ience - most "ecent %i"st( Position Emplo!e"2P"o<ect D/ties Date %"om Date to

All information provided in this form is confidential to the Selection Board (This form should be typed or completed using block capitals in black ink)

Please in$icate

"ie%l! !o/" /n$e"stan$in& o% the "ole o% a Special Nee$s Assistant

All information provided in this form is confidential to the Selection Board (This form should be typed or completed using block capitals in black ink)

A$$itional in%o"mation 7 not already mentioned 9 in s/ppo"t o% !o/" application

Please &i5e the names o% t4o "e%e"ees: one sho/l$ e in a position to comment on !o/" pe"sonal cha"acte"istics an$ one sho/l$ e in a position to comment on !o/" p"o%essional @/ali%ications an$2o" t"ainin&( Re%e"ees sho/l$ not e "elate$ to the applicant( 7,9 Name A$$"es s 7.9 Name

A$$"ess

Phone N/m e"7s9-

Ao"B: -ome: Mo ile:

Phone N/m e"7s9 C

Ao"B: -ome: Mo ile:

* As it is probable that referees will have to be contacted outside of school times, it is crucial that phone numbers at
which referees can be contacted (three if possible) are given. 9
Si&nat/"e o% Applicant

Date