EMPLOYEE RECORD FORM:

Educational Research Centre

St. Patrick’s College
Drumcondra
Dublin 9
Telephone: 01-8373789

Full Name: _________Ricky Ó Catháin________________________________

Address: ______________The Wood,______________________________

_________________Dingle,_____________________________________________

_________________Co. Kerry, V92TD30_________________________________

Telephone No: ____0872839209_________ Date of Birth: ___23/04/1998______

E-mail
Address:________rickykeane98@gmail.com_____________________________
Do you want you payslip e-mailed to you Yes/No ______________________

PPS No (PRSI No) _______8991662B_____________PRSI Class _____________

NB If you don’t know your PRSI class please see overleaf.

Will this be your main Employment? Yes/No __________Yes_____________

Excluding any Pension income, if retired.
Date you commenced employment in the Centre: ____29/04/2021_____________

Area of employment in the Centre: _________IT/Testing___________________

Were you previously employed here, if yes approx when________________

Were you employed in a similar capacity elsewhere prior to 2011 ________

DETAILS OF YOUR BANK ACCOUNT

Name of Bank: ______AIB_________________________________

Address: _________16 Main Street,________________________
__________Dingle,________________________________
___________Co. Kerry___________________________

IBAN: ___IE73AIBK93012126749186__Sort Code___930121___

BIC: ______AIBKIE2D___________Account No___26749186___
Bank Account Type: ________Current______________________
(Current, Deposit or Joint a/c etc)

N.B. This form must be fully completed otherwise payment cannot be processed.
Please ensure that you have completed both pages and signed the form.
This form should be completed by New Employees being paid for the first time or
existing Employees advising of change of address or bank details already on file
PTO
 2

PRSI CLASS - The following information will help us to determine your correct PRSI
Class.

(i) Were you employed in the Public Service prior to April 1995 and paying modified PRSI
Yes/No ________No_________

If Yes
Do you have any break in service other than leave _________________________

Please give details and dates __________________________________________

(ii) Are you in receipt of any Social Welfare payments? If so which one ____N/A_________

(Lone Parent-Widow/Widowers or Old Age Pension)

(iii) Are you employed elsewhere? ____Yes___ If yes, state PRSI class applied _____J___

PENSION LEVY - In order to establish if you are exempt from the Pension Levy please
answer the following questions.

(i) Are you in receipt of any pension? If yes please give details (i.e. State – Old Age Pension,
Retired Teacher, Civil Service or Semi State) _______No________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

(ii) Are you employed elsewhere and contributing to a Pension Scheme? If yes please give details
(i.e. Civil Service or Semi State) ______________No________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

(iii) Did you contribute to a Public Service Pension Scheme at any stage in the past. If yes please
give details (i.e. was it refunded or is there a deferred benefit)_________No____
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

PREVIOUS EMPLOYMENT
If you were employed previously in a similar capacity elsewhere prior to January 2011
Please give details including dates:_________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Signature: ____
___________
Date: ______12/04/2021______________________