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 BIOGRAPHICAL INFORMATION:  ( * question MUST be answered )

Name
Surname * :
First Names * :
Name as on Birth Certificate:
Surname * :
First Names * :
Are you a current HSE Employee?  * :			Yes No
Address for Correspondence * :			Rep. of Ireland Other Country
Main Contact Mobile Phone Number * :			eg 353871234567
Telephone Number:
Are you an EEA (European Economic Area) National ?  * : Yes No Please see Appendix 1 in Additional Campaign Information for further information regarding non EEA applicants.
Please note : If you are a Non EEA National, you will be requested by the HSE to provide documentation to support this declaration after the closing date for applications.
Please indicate if you wish to undertake an Irish assessment exam * :  Yes No
Most recent Educational Institution Attended * :			Secondary School Irish University Irish Institute of Technology Other Irish Higher Education Institution Post Leaving Cert College Other Unknown
Please note that you are required to answer additional questions as part of your application. Please see download for completion and submission to Postgraduate Applications Centre by 12 noon Friday 15th March 2019.

Higher Education Institution (HEI) linked to HSE Maternity Sites : Choose in order of preference. Please note successful candidates will only receive one offer which must be accepted or declined. Choices in dropdown as follows: University College Cork (UCC)/Cork University Maternity Hospital (CUMH); National University of Ireland, Galway (NUIG) / University Hospital, Galway (UHG); University of Limerick (UL)/ University Maternity Hospital Limerick (UMHL); Dundalk Institute of Technology (DKIT) / Our Lady of Lourdes Hospital (OLOL).
* Preference 1			Choose HEI preference... University College Cork National University of Ireland, Galway University of Limerick, Limerick Dundalk Institute of Technology
Preference 2			Choose HEI preference... None University College Cork National University of Ireland, Galway University of Limerick, Limerick Dundalk Institute of Technology
Preference 3			Choose HEI preference... None University College Cork National University of Ireland, Galway University of Limerick, Limerick Dundalk Institute of Technology
Preference 4			Choose HEI preference... None University College Cork National University of Ireland, Galway University of Limerick, Limerick Dundalk Institute of Technology

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