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* question MUST be answered
Name:
*
Surname :
*
First Names :
Name as on Birth Certificate:
*
Surname :
*
First Names :
*
Are you a current HSE Employee? :
Yes
No
*
Are you a registered Midwife? :
Yes
No
*
Address for Correspondence :
Rep. of Ireland
Other Country
*
Main Contact Mobile Phone Number :
Telephone Number:
*
Are you an EEA national? :
Yes
No
Please see Appendix 5 of Additional Campaign Information for definition of an EEA National.
Please note that if you are a non-EEA national you will be asked for evidence, after the closing date, of relevant documentation pertaining to your permission to reside and work in Ireland. Failure to forward documents in the timescale requested will result in your application being considered incomplete and will not be processed any further.
The HSE will contact you for this documentation after the closing date.
Where vacancies arise for which proficiency in Irish is a management requirement, the HSE will offer such posts in order of merit to the candidate who has successfully passed an Irish assessment. This assessment will be on a pass/fail basis and will not disturb the marks awarded in the selection process.
*
Please indicate if you wish to undertake an Irish assessment exam :
Yes
No
*
Most recent Educational Institution Attended :
Secondary School including (Vocational, Community, comprehensive, private)
Irish University
Irish Institute of Technology
Other Irish Higher Education Institution
Post Leaving Cert College
Other
Unknown
Higher Education Institution (HEI) Choices:
*
Preference 1
Choose HEI preference...
National University of Ireland, Galway
University College Cork
University College Dublin
*
Preference 2
Choose HEI preference...
None
National University of Ireland, Galway
University College Cork
University College Dublin
*
Preference 3
Choose HEI preference...
None
National University of Ireland, Galway
University College Cork
University College Dublin
HSE Geographical Areas (GA):
*
Geographical Area Preference 1
Choose preferred area...
---
Clare
Mayo
North Tipperary / East Limerick
Sligo/Leitrim
---
Carlow/Kilkenny
Cork – North Lee
Cork – South Lee
North Cork
South Tipperary
Waterford
Wexford
---
Dublin South City (Area 3)
Dublin South East (Area 2)
Dublin South West (Area 4)
Dublin West (Area 5)
Dun Laoghaire (Area 1)
Kildare/West Wicklow (Area 9)
Laois/Offaly
Longford/Westmeath
Wicklow (Area 9)
---
Cavan/Monaghan
Louth
Meath
North Central Dublin (Area 7)
North Dublin (Area 8)
North West Dublin (Area 6)
*
Geographical Area Preference 2
Choose preferred area...
None
---
Clare
Mayo
North Tipperary / East Limerick
Sligo/Leitrim
---
Carlow/Kilkenny
Cork – North Lee
Cork – South Lee
North Cork
South Tipperary
Waterford
Wexford
---
Dublin South City (Area 3)
Dublin South East (Area 2)
Dublin South West (Area 4)
Dublin West (Area 5)
Dun Laoghaire (Area 1)
Kildare/West Wicklow (Area 9)
Laois/Offaly
Longford/Westmeath
Wicklow (Area 9)
---
Cavan/Monaghan
Louth
Meath
North Central Dublin (Area 7)
North Dublin (Area 8)
North West Dublin (Area 6)
*
Geographical Area Preference 3
Choose preferred area...
None
---
Clare
Mayo
North Tipperary / East Limerick
Sligo/Leitrim
---
Carlow/Kilkenny
Cork – North Lee
Cork – South Lee
North Cork
South Tipperary
Waterford
Wexford
---
Dublin South City (Area 3)
Dublin South East (Area 2)
Dublin South West (Area 4)
Dublin West (Area 5)
Dun Laoghaire (Area 1)
Kildare/West Wicklow (Area 9)
Laois/Offaly
Longford/Westmeath
Wicklow (Area 9)
---
Cavan/Monaghan
Louth
Meath
North Central Dublin (Area 7)
North Dublin (Area 8)
North West Dublin (Area 6)
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