Primary Qualification
Other Qualification(s)
Professional Qualification
Professional Experience
References
English Competency
Competency Based Questions
Other Information
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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:
1st Class Honours
2nd Class Honours
2nd Class Honours (Grade 1)
2nd Class Honours (Grade 2)
3rd Class Honours
Distinction
Merit
Pass
Pending
Awarded
Other (Please Specify)
If Other Please Specify:
Name of Education Institution Attended:
All Hallows College
American College Dublin
Athlone Institute of Technology
Burren College
Carlow College
Church of Ireland, College of Education
Colaiste Mhuire
Cork Institute of Technology
Dublin Business School
Dublin City University
Dublin Institute of Technology
Dun Laoghaire Institute of Art, Design & Technology
Dundalk Institute of Technology
Froebel College of Education
Galway-Mayo Institute of Technology
Griffith College Dublin
Institute of Technology Blanchardstown
Institute of Technology, Carlow
Institute of Technology, Sligo
Institute of Technology, Tallaght
Institute of Technology, Tralee
Limerick Institute of Technology
Letterkenny Institute of Technology
LSB College
Mary Immaculate College, Limerick
Mater Dei Institute of Education
Milltown Institute
National College of Art & Design
National College of Ireland
NUI Galway (formerly UCG)
NUI Maynooth
Pontifical University Maynooth
Portobello College
Royal College of Surgeons
Shannon College of Hotel Management
St Angelas College
St Catherines College of Education
St Patricks College, Drumcondra
Tipperary Institute
Tipperary Rural and Business Development Institute
Trinity College Dublin
University College Cork
University College Dublin
University of Limerick
Waterford Institute of Technology
Other (Ireland)
Other (Outside Ireland)
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:
1st Class Honours
2nd Class Honours
2nd Class Honours (Grade 1)
2nd Class Honours (Grade 2)
3rd Class Honours
Distinction
Merit
Pass
Pending
Awarded
Other (Please Specify)
If Other Please Specify:
Name of Education Institution Attended:
All Hallows College
American College Dublin
Athlone Institute of Technology
Burren College
Carlow College
Church of Ireland, College of Education
Colaiste Mhuire
Cork Institute of Technology
Dublin Business School
Dublin City University
Dublin Institute of Technology
Dun Laoghaire Institute of Art, Design & Technology
Dundalk Institute of Technology
Froebel College of Education
Galway-Mayo Institute of Technology
Griffith College Dublin
Institute of Technology Blanchardstown
Institute of Technology, Carlow
Institute of Technology, Sligo
Institute of Technology, Tallaght
Institute of Technology, Tralee
Limerick Institute of Technology
Letterkenny Institute of Technology
LSB College
Mary Immaculate College, Limerick
Mater Dei Institute of Education
Milltown Institute
National College of Art & Design
National College of Ireland
NUI Galway (formerly UCG)
NUI Maynooth
Pontifical University Maynooth
Portobello College
Royal College of Surgeons
Shannon College of Hotel Management
St Angelas College
St Catherines College of Education
St Patricks College, Drumcondra
Tipperary Institute
Tipperary Rural and Business Development Institute
Trinity College Dublin
University College Cork
University College Dublin
University of Limerick
Waterford Institute of Technology
Other (Ireland)
Other (Outside Ireland)
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:
1st Class Honours
2nd Class Honours
2nd Class Honours (Grade 1)
2nd Class Honours (Grade 2)
3rd Class Honours
Distinction
Merit
Pass
Pending
Awarded
Other (Please Specify)
If Other Please Specify:
Name of Education Institution Attended:
All Hallows College
American College Dublin
Athlone Institute of Technology
Burren College
Carlow College
Church of Ireland, College of Education
Colaiste Mhuire
Cork Institute of Technology
Dublin Business School
Dublin City University
Dublin Institute of Technology
Dun Laoghaire Institute of Art, Design & Technology
Dundalk Institute of Technology
Froebel College of Education
Galway-Mayo Institute of Technology
Griffith College Dublin
Institute of Technology Blanchardstown
Institute of Technology, Carlow
Institute of Technology, Sligo
Institute of Technology, Tallaght
Institute of Technology, Tralee
Limerick Institute of Technology
Letterkenny Institute of Technology
LSB College
Mary Immaculate College, Limerick
Mater Dei Institute of Education
Milltown Institute
National College of Art & Design
National College of Ireland
NUI Galway (formerly UCG)
NUI Maynooth
Pontifical University Maynooth
Portobello College
Royal College of Surgeons
Shannon College of Hotel Management
St Angelas College
St Catherines College of Education
St Patricks College, Drumcondra
Tipperary Institute
Tipperary Rural and Business Development Institute
Trinity College Dublin
University College Cork
University College Dublin
University of Limerick
Waterford Institute of Technology
Other (Ireland)
Other (Outside Ireland)
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:
1st Class Honours
2nd Class Honours
2nd Class Honours (Grade 1)
2nd Class Honours (Grade 2)
3rd Class Honours
Distinction
Merit
Pass
Pending
Awarded
Other (Please Specify)
If Other Please Specify:
Name of Education Institution Attended:
All Hallows College
American College Dublin
Athlone Institute of Technology
Burren College
Carlow College
Church of Ireland, College of Education
Colaiste Mhuire
Cork Institute of Technology
Dublin Business School
Dublin City University
Dublin Institute of Technology
Dun Laoghaire Institute of Art, Design & Technology
Dundalk Institute of Technology
Froebel College of Education
Galway-Mayo Institute of Technology
Griffith College Dublin
Institute of Technology Blanchardstown
Institute of Technology, Carlow
Institute of Technology, Sligo
Institute of Technology, Tallaght
Institute of Technology, Tralee
Limerick Institute of Technology
Letterkenny Institute of Technology
LSB College
Mary Immaculate College, Limerick
Mater Dei Institute of Education
Milltown Institute
National College of Art & Design
National College of Ireland
NUI Galway (formerly UCG)
NUI Maynooth
Pontifical University Maynooth
Portobello College
Royal College of Surgeons
Shannon College of Hotel Management
St Angelas College
St Catherines College of Education
St Patricks College, Drumcondra
Tipperary Institute
Tipperary Rural and Business Development Institute
Trinity College Dublin
University College Cork
University College Dublin
University of Limerick
Waterford Institute of Technology
Other (Ireland)
Other (Outside Ireland)
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)
*
Registered General Nurse
*
/
/
dd/mm/yyyy
Additional Professional Qualifications:
Date of Registration with Nursing and Midwifery Board of Ireland (NMBI)
Registered Midwife
Registered Nurse Tutor
Registered Paediatric Nurse
Registered Psychiatric Nurse
Registered Intellectual Disability Nurse
/
/
dd/mm/yyyy
Registered Midwife
Registered Nurse Tutor
Registered Paediatric Nurse
Registered Psychiatric Nurse
Registered Intellectual Disability Nurse
/
/
dd/mm/yyyy
Registered Midwife
Registered Nurse Tutor
Registered Paediatric Nurse
Registered Psychiatric Nurse
Registered Intellectual Disability Nurse
/
/
dd/mm/yyyy
Registered Midwife
Registered Nurse Tutor
Registered Paediatric Nurse
Registered Psychiatric Nurse
Registered Intellectual Disability Nurse
/
/
dd/mm/yyyy
Registered Midwife
Registered Nurse Tutor
Registered Paediatric Nurse
Registered Psychiatric Nurse
Registered Intellectual Disability Nurse
/
/
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 Wednesday 16th May 2018.
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:
*
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 Experience relevant to the Role
The ability to function effectively in the role as described in the job spec.
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.
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