Apply Online Day Course Application Form COURSE APPLIED FOR: Course 1: Hairdressing Year 1 - Junior TradesHairdressing Year 2 - Senior Trades ITECCommunity Healthcare AssistantRetail Sales Assistant -FITComputers and on-line Customer ServiceWarehousing Skills - FITSport Recreation and Exercise Course 2: Hairdressing Year 1 - Junior TradesHairdressing Year 2 - Senior Trades ITECCommunity Healthcare AssistantRetail Sales Assistant -FITComputers and on-line Customer ServiceWarehousing Skills - FITSport Recreation and Exercise Course 3: Hairdressing Year 1 - Junior TradesHairdressing Year 2 - Senior Trades ITECCommunity Healthcare AssistantRetail Sales Assistant -FITComputers and on-line Customer ServiceWarehousing Skills - FITSport Recreation and Exercise PERSONAL DETAILS First Name Surname Home Address Email Confirm Email Country of Birth Nationality Date of Birth Gender MaleFemale PPS Number (must be supplied) Mobile Number Land Line Address while attending College (if different from above) Mother's Maiden Name First Name Surname NEXT OF KIN DETAILS: First Name Surname Contact Number Do you have a medical card? YesNo Card Number Expiry Date Do you have any medical conditions the College should be aware of? YesNo Do you have a specific learning disability? YesNo EDUCATIONAL DETAILS What year did you leave school/college? Name of school/college last attended Address of school/college What is your highest educational qualification? ---No qualificationsGroup CertificateIntermediate CertificateJunior CertificateLeaving CertificateFETAC 3FETAC 4FETAC 5FETAC 6Primary Degree (pass)Primary Degree (Honours)MastersPhD What year did you receive that qualification? If you have attended CityNorth College before, please state course name and years attended Course Name: Years Attended: EMPLOYMENT STATUS Before applying to this college, were you: EmployedUnemployedStudent If employed, what was your occupation? If unemployed, how long for? years: months: SOCIAL WELFARE STATUS Are you receiving a Social Welfare payment? YesNo If yes, which one: ---Back to Work AllowanceCarers AllowanceCommunity EmployContributory pensionDisability AllowanceDisability Benefit (6 months)Employed PTFamily Income SupplementJob Seekers AllowanceJob Seekers BenefitLone Parent AllowanceOther Where did you hear about us? General Admissions Information All courses are interview based. The College will post you an interview date for your chosen course. If you do not hear from the College by the 7th August 2017 please contact the office on 0214391782 or 0214397740 or Email firstname.lastname@example.org Note for International Students: if English is not your first language you must complete a compulsory English Language Assessment. The College will assign you the date of your Language Assessment. Please refer to the college website www.citynorthcollege.ie under the link International Students 2017 to read the requirements and exemptions for International Applicants. Data Protection Note Personal Data on this Form The Cork ETB is registered as a Data Controller under the Data Protection Acts 1988 and 2003. The personal data supplied on this application form is required for the purposes of student enrolment, registration, administration, child welfare and to fulfil our other legal obligations. Contact details will also be used to notify you of college/Cork ETB events or activities. While the information provided will generally be treated as confidential to the Cork ETB, from time to time it may be necessary for us to exchange personal data on a confidential basis with other bodies including the Department of Education & Skills, the Department of Social Protection, An Garda SÌoch·na, the Health Service Executive, the National Educational Welfare Board or with another school/college (where the student is transferring). We rely on students and parents/guardians where a student is under the age of 18, to provide us with accurate and complete information and to update us in relation to any change in the information provided. Should you wish to update or access your/your child's personal data you should write to the college Principal. By submitting this form you are indicating that you accept that your data may be used for the purposes above. Data Protection Policy of the Cork ETB A copy of the full Data Protection Policy of the Cork ETB is available at www.cork.etb.ie or on request from The CEO, Cork ETB, 21 Lavitt's Quay, Cork.