Synergy Security Solutions

Please assist our Human Resource Department by filling out all boxes marked blue. The remainder of the information requested here, while non-essential at this point, will assist our staff greatly during your Screening & Vetting period if you were to be employed by us.

N.B. All information given will be treated in the strictest of confidence.


Application For Employment As:
County:
1. Personal Information
Surname*
Forenames*
Previous Surname(s)
Date Of Birth
Current Address*
National Insurance (PRSI) No.
Nationality
Home Telephone No.
Mobile Telephone No.*
Email*
Marital Status
Number Of Dependants
Age(s) Of Dependants
Partners Occupation
Do You Hold A Current Driving License?*
If Yes, How Long Held?
License Number
Details Of Any Endorsements
Do You Have Access To A Vehicle?*

2. Work Permits
Are there any restrictions to your
residence inIreland that might affect
your right to take up employment in
Ireland?*
If you are successful in your application
would you require a work permit to work
in Ireland?*
If yes, give details

3. Licensing
Do You Hold A Current PSA License?*
PSA License Number
License Type
Renewal Date
Have you spent 6 consecutive months
or more outside of Ireland within the
past 5 years? *
If yes, give details

give details of any previous addresses
held over the past 5 years		 From: To:

From: To:

4. Physical Record
Height
Weight
Do you have normal vision without
glasses/contact lenses?
Do you have normal vision with
glasses/contact lenses?
Do you have normal hearing?
Are you colour blind?
Do you have a normal sense of smell?
Are you in good health?

Do you now, or have you at any time during the last
8 years suffered from any of the following conditions?
High/Low Blood Pressure?
Diabetes?
Respiratory Conditions?
Slipped Disc or Back Trouble?
Angina / Heart Problems?
Nervous or Mental Disorders / Stress
Epilepsy
Fainting / Migraine / Headaches
Are you at present, or have you during the past
six months taken any medication or treatment
prescribed by a doctor?
Have you been absent from, or unable to work
during the last two years?
Do you have any reason to think that you may
not be sufficiently fit to work at night? *
If yes to any of the above medical conditions,
please give details

5. Background Information
Have you ever been...
Cautioned? *
Discharged On Payment Of Costs? *
Fined? *
Placed On Probation? *
Sentenced To Imprisonment? *
Or had any order made against you by a
civil, military court or public authority? *
Do you have any prosecutions pending? *
Are there any alleged offences outstanding
against you? *
Have you ever been declared bankrupt? *
Are there any outstanding judgements for
debt against you? *
If yes to any of the above, please give details

6. Service Record
Have you ever served in An Garda Siochana
or The Defence Forces?
Date Joined
Date Discharged
Conduct Record
Regiment
Branch or Division
Rank
Service Number

7. Employment Record
Please take great care in entering the full postal addresses and employment dates,
inaccuracies may lead to a delay in your employment. You must give, in date order,
details of every job you have had for the last ten years, or since you left full time
education. For any period of unemployment give the address of the office to which you
reported and dates.
Employers Name And Address
Person To Whom You Reported
Employment Dates From: To:
Position Held
Reason For Leaving
Employers Name And Address
Person To Whom You Reported
Employment Dates From: To:
Position Held
Reason For Leaving
Please give details of all schools or colleges attended over the past 10 years
Name of school or college
Attendance Dates From: To:
Name Of Tutor
Reason For Leaving
Name of school or college
Attendance Dates From: To:
Name Of Tutor
Reason For Leaving
If you have been self employed, please give the names and addresses of two people who
can confirm this. They may be firms with whom you have traded, your solictor
or accountant.
Trade References
Name & Address
How Long Known
Occupation Or Business
Trade References
Name & Address
How Long Known
Occupation Or Business

8. Character References
Give names and addresses of three persons, not relatives or employees of Synergy Security, who have known you for at least two years within the past five years,
whom we may approach for a Character Reference.
Failure to complete in full will cause delay.
Name *
Occupation *
Telephone *
Address *
Name *
Occupation *
Telephone *
Address *
Name *
Occupation *
Telephone *
Address *

9. Educational, Professional, Technical or Linguistic Qualifications
Please Give Details

10. Details Of Any First Aid Qualifications
Please Give Details

strong>11. Details Of Next Of Kin
Name
Relationship
Telephone No.
Address

12. Equal Opportunities
You are not required to provide the information requested below. If you choose to do so it will not
be used to influence our consideration of your application in any way. Any information you provide
in this section will be used solely to monitor the effectiveness of our equal opportunities policy.
I would describe my ethnic origin as
If "other" please specify

13. Applicant Statement
please read the following statement and type your full name into
the 'I Agree' box before submitting the form.
I certify that to the best of my knowledge, the information I have given is complete and
correct, and I understand that misrepresentation of facts is ground for immediate
dismissal and renders me liable for prosecution. I authorise the Company to approach
any Government Agencies, former employers and personal referees to verify the
information given, and will supply a Statutory Declaration if required. I understand that
employment, if offered, is subject to satisfactory screening or medical examination as
determined by the company.
I AGREE *
Please enter your full name before submitting the form
* Required Fields