Statement of Employment / Education / Travel History

⚠️ Important: Please complete this form in chronological order, covering each period of time since you completed your Leaving Certificate (or its equivalent).

All time periods must be listed consecutively, with no gaps, including any periods of unemployment, travel, or time spent outside the workforce.

For each entry, full addresses (including town, county, and country) are required, in accordance with HIQA requirements

When this form has been completed please save as a PDF file to your downloads folder using the button provided. Please then email the saved form to your recruiter. The form is not automatically shared with us.