Educational Qualifications
Please note the information below does not form part of the eligibility assessment for the campaign. The information is for HEI registration purposes only.

 Undergraduate 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:
 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:
 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
Details of Professional Registration:


Professional Registration:

Date of Registration with Nursing and Midwifery Board of Ireland (NMBI)
    * / / dd/mm/yyyy  

Nursing and Midwifery Board of Ireland
(NMBI) PIN number  * 		 
 
 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
 
 Qualification in General Nursing Achieved:
 Professional Experience *:
 Please note that you are required to provide verification of post registration experience as a RGN claimed below.
 Please see download for completion and submission to to Postgraduate Applications Centre
 by 12 noon Friday 15th March 2019.

 Applicants must be registered in the General Nursing Division of the Register of Nurses maintained by NMBI or
 entitled to be so registered and have a minimum of 6 months post registration experience as an RGN within the
 past 3 years, working a minimum of 78 hours per month.
 Please note that you must have achieved the required experience no later than 12 noon Friday 15th March 2019.
 Please detail below 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.
 
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)
e.g Type of Experience and role responsibilities (You must specify in this column the type of experience for each post ie: Acute/Medical/Elderly etc. You are advised to give as much detail as possible regarding your role & responsibilities in each post. Failure to do so may render your application ineligible)
 Total Cumulative Months    

 Please click here to add additional Professional Experience
 
 References  *: 
 Applicants: Please give three referees (including your current /most recent Director of Nursing).
You must provide valid telephone numbers and email addresses for all your referees.
Referees must be at Director level. We retain the right to contact all previous employers.
Do you wish us to contact you prior to contacting your referees?

 *Referee 1
 Name:  
 Address:  
 Position:  
 Phone No.:  
 Email:  
 
 *Referee 2
 Name:  
 Address:  
 Position:  
 Phone No.:  
 Email:  
 
 *Referee 3
 Name:  
 Address:  
 Position:  
 Phone No.:  
 Email:  
 
 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 student midwife.
The skills and qualities are outlined in the questions below.
It is strongly recommended that you prepare competency based answers in a text file for your own records and paste them into the application form.

 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
 
N.B.
Please note that all competency based questions must be completed and submitted at the time of application. You are required to complete each question in no less than 300 words.
Failure to complete all sections will result in your application not being processed further.
 1. Organisation and Management Skills
   It is important that the Student Midwife 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. Analysis, Problem Solving & Decision Making Skills
     The effective Student Midwife 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.
     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 Student Midwife 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. Please provide highlights from your career to date that you feel make you particularly suited to the role of the      midwife.
     

 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 Other (Please specify below)
          Specify here:
 
 I confirm that I have read the General Declaration and I accept it’s content. *         
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 I wish to continue with my application.
 I wish to save my incomplete application and exit.