Details of Higher Education (Please indicate your primary degree and other
 degrees/qualifications which form the basis of your consideration for this programme).
 Undergraduate Degree Title:
     Degree Title English Translation (if applicable):
 Class of Award:
                                      If Other Please Specify:
 Name of Education Institution Attended:
                                       If Other Please Specify:
 Address of Education Institution Attended:
 Period of Attendance: From (yyyy):    To (yyyy): 
 Main Subjects Studied:
 Have you completed the programme: Yes No
 
 Additional relevant qualifications (Give details of other relevant qualifications attained)
 Title of other Degree/Qualification:
                             English Translation (if applicable):
 Class of Award:
                                           If Other Please Specify:
 Name of Education Institution Attended:
                                           If Other Please Specify:
 Address of Education Institution Attended:
 Period of Attendance:  From (yyyy):    To (yyyy): 
 Main Subjects Studied: 
 Have you completed the programme:  Yes No
 

 Title of Other Degree/Qualification:
                            English Translation (if applicable):
 Class of Award:
                                           If Other Please Specify:
 Name of Education Institution Attended:
                                           If Other Please Specify:
 Address of Education Institution Attended:
 Period of Attendance:  From (yyyy):    To (yyyy): 
 Main Subjects Studied: 
 Have you completed the programme:  Yes No
 

 Title of Other Degree/Qualification:
                             English Translation (if applicable):
 Class of Award: 
                                           If Other Please Specify:
 Name of Education Institution Attended:
                                           If Other Please Specify:
 Address of Education Institution Attended:
 Period of Attendance:  From (yyyy):    To (yyyy): 
 Main Subjects Studied: 
 Have you completed the programme:  Yes No
 
If you are not registered in the General Division of the Register of Nurses maintained by Nursing and Midwifery Board of Ireland (NMBI) but are entitled to be so registered please enter 000000 in the Nursing and Midwifery Board of Ireland (NMBI) number and 00/00/0000 in the date of  Registration with Nursing and Midwifery Board of Ireland (NMBI) .
 * Nursing and Midwifery Board of Ireland (NMBI) number: 
 
 Details of Professional Qualifications:    Date of Registration with An Nursing and Midwifery Board of Ireland (NMBI)
 
  *                   * / /  dd/mm/yyyy  
 
 Additional Professional Qualifications:  Date of Registration with Nursing and Midwifery Board of Ireland (NMBI)
  / /  dd/mm/yyyy
 
  / /  dd/mm/yyyy
 
/ /  dd/mm/yyyy
 
/ /  dd/mm/yyyy
 
/ /  dd/mm/yyyy
 
 Other Professional Qualification:
 * Professional Experience:

Applicants must be registered in the General Division of the Register of Nurses maintained by Nursing and Midwifery Board of Ireland (NMBI) or entitled to be so registered and have a minimum of 3 years post registration experience as a registered general nurse within the past 7 years, working 39 hours per week*, or its equivalence within the last 7 years if working less hours (*From 08/04/2010 to 30/06/2013 working a 37.5 hours per week).
Please note that you must have achieved the required experience no later than Friday 12th May 2017.

Please detail below (in months) your experience to date that demonstrates your fulfilling of the above eligibility criteria. Please state clearly your “From date” and “To Date“ in Day/Month/Year format.
Please note that the information supplied here will be used to determine your eligibility for this campaign.
If you work in a part-time capacity please list your monthly hours and total months of work. Please do not make whole time equivalent calculations.
You are required to submit verification of this experience with your application on HSE Supplementary Form 2.
From Date (dd/mm/yyyy) //
To Date (dd/mm/yyyy) //
Average Monthly Hours
Total Months
Employer
Full time
Part time
Full time Part time
Title of Post (Position held)
Type of experience
e.g Acute/Medical/Elderly/Paediatrics
Midwifery/Public Health etc.
 Total Cumulative Months    

 Please click here to add additional Professional Experience
 
Please indicate below if you have a minimum of 3 years post registration experience as a registered general nurse within the past 7 years, working 39 hours per week*, or its equivalence within the last 7 years if working less hours (*From 08/04/2010 to 30/06/2013 working a 37.5 hours per week)..
Please note that if you tick “no” you will be unable to continue with your application as you are indicating that you do not meet the eligibility criteria listed above.
 
You have a minimum of 3 years post registration experience as a registered general nurse within the past 7 years, working 39 hours per week*, or its equivalence within the last 7 years if working less hours (*From 08/04/2010 to 30/06/2013 working a 37.5 hours per week)
  Yes No
 
 * References : 
 Applicants must provide the names of three referees. One must be your current or most recent employer at Director of Nursing level or equivalent. The second referee listed must fulfil the same criteria as above and be from a previous employer. The HSE reserves the right to contact all previous employers.

 *Reference 1
 Name:  
 Address:  
 Position:  
 Phone No.:  
 Email:  
 *Reference 2
 Name:  
 Address:  
 Position:  
 Phone No.:  
 Email:  
 *Reference 3
 Name:  
 Address:  
 Position:  
 Phone No.:  
 Email:  
 * English Language Competency: : 

 Is English your first language or primary language of expression: Yes No

 For applicants whose first language or primary language of expression is not English: 

 Have you completed an IELTS exam:
Yes No
 Date of Completion: / /  dd/mm/yyyy
 Score:
 
 Supplementary Information  
 
 * Competency Based Questions
 In this following section, you are required to describe some of your personal achievements to date that demonstrate
 certain necessary skills and qualities required for the position of Public Health Nurse.
 The skills and qualities are outlined in the Questions Areas 1 – 4.

 All question areas must be completed. Please read “Guidelines for completing the Competency Based Questions” and  remember that you will be questioned on all areas at interview if you are called to one.
 Please note that the information you provide here will also be taken into account as part of the shortlisting process.
 The instructions below will help you to complete your answers, but you should also consider these
 instructions when you are preparing for interview. Guidelines for completing the Competency Based Questions
 
  You are required to complete each example in no less than 300 words. One of the key skills required of the Student PHN/PHN is the ability to write clearly and concisely and your written communication skills will be assessed against what you write on your application form.
 1. Organisation and Management Skills
     It is important that the Public Health Nurse has the ability to plan and organise resources, reviewing and prioritising
     as appropriate. S/he will demonstrate initiative and innovation, be flexible in approach to his / her workload and
     be open to change. In the space below, please give an example of a situation where you best demonstrated your
     ability in this area.
     
 
 2. Professional Knowledge
     The ability to function effectively in the role as described in the job spec. In the space below, please give an
     example of a situation where you best demonstrated your ability in this area.
     
 
 3. Building & Maintaining Relationships
     It is important that a Public Health Nurse demonstrate good interpersonal skills and the ability to build and maintain      relationships. S/he will have the ability to work independently as well as part of a wider healthcare team and display      a supportive work style including strong empathy. In the space below, please give an example of a situation where
     you best demonstrated your ability in this area.
     
 
 4. Analysis, Problem Solving & Decision Making
     The effective Public Health Nurse will demonstrate sound professional judgement in decision making. S/he will
     break problems into component parts and address these in a systematic manner, anticipating the
     implications / consequences of different solutions before taking action.
     
 
 * Where did you hear about the programme/s you are applying for ? : 
Academic Staff Advertisement Careers Fair/Exhibition (International) Careers Fair/Exhibition (Ireland)
University Prospectus (hard copy) University Prospectus (online) University Website Other Internet Sites
Press/Journal Article Word of Mouth Your Careers Office Other    If Other Please Specify:
 
 
 * I confirm that I have read the General Declaration and I accept it’s content.          

>>>  
 

 I wish to continue with my application.
 I wish to save my incomplete application and exit.