All sections to be completed in full

APPLICATION FORM
Clinical Nurse/Midwife Manager 1, Gynaecology, Maternity Services,
University Hospital Kerry
Ref: UHKM64838

Thank you for applying for a post within South/South West Hospital Group.
Please carefully note the following instructions:

 Please read the Job Specification which provides useful information about the requirements of this post.

 Please ensure you read the instructions for the completion of this Application Form and complete all
areas, in full. Failure to complete all areas of the Application Form will result in you not being brought
forward to the interview stage of the selection process. In relation to details of employment, if the space
provided is insufficient, please attach additional pages ensuring to use the same format.

 Please use the following browsers when applying: Firefox, Google Chrome & Edge

 Completed application forms should be uploaded to the Rezoomo Recruitment page, please note
Email applications will not be accepted. CV’s will not be accepted. We recommend that
applicants wishing to submit an application should allow a minimum of 1 hour for their
application to arrive by 12.00 noon on the closing date. Applications will not be accepted after
this date and time, no exceptions will be made.

 An eLearning programme to guide and support candidates in applying for roles in the HSE, from the
initial application through to the interview itself has been implemented. The ‘Getting a Job in the HSE’
eLearning programme is made up of three modules running 10-20 minutes each, with an approximate
total duration of 45 minutes. The programme is available to existing HSE staff on HSeLanD by searching
for ‘Getting a Job in the HSE’. External candidates can access the modules on
[Link]

 To ensure that you do not miss out on any email communication it is highly recommended that you
check your spam and junk folder on a regular basis.

 The Health Service Executive will run this campaign in compliance with the Code of Practice prepared
by the Commission for Public Service Appointments (CPSA). The Codes of Practice are available on the
CPSA website [Link]. Further information is also available in the Additional Campaign Information
document.

 The Health Service Executive is an Equal Opportunities Employer.

 The Health Service Executive recognises its responsibilities under the Data Protection Acts 1988 to
2018 and the Freedom of Information Act 2014.

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Completed applications forms must be submitted via:

PLEASE COMPLETE APPLICATION FORM AND SUBMIT THROUGH OUR REZOOMO RECRUITMENT
PAGE
Closing date for applications: 12 noon on Thursday 30th of May 2024.
Proposed interview dates will be indicated at a later stage. Interviews will be held as soon as possible
after the closing date. Candidates will normally be given at least one weeks' notice of interview. The timescale
may be reduced in exceptional circumstances.

APPLICANT DETAILS
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 Clinical Nurse/Midwife Manager 1, Gynaecology, Maternity
Position Applied for: Services
Position Reference No.: UHKN64838

Candidate Reference No (office use only)

Personal Details:
First name :
Last Name:

Postal address for correspondence:

Mobile Telephone (mandatory):

Contact Telephone No. 2

E-mail Address (mandatory):

(You may provide more than one)

Drivers Licence (please state type & category):

European Economic Area

Are you an EEA (European Economic Area) National? Yes / No

1. EEA Nationals
EEA nationals who do not require work permits / visas / authorizations are nationals of the following
countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, The
Netherlands, Portugal, Spain, Sweden, United Kingdom, Cyprus, Czech Republic, Estonia, Hungary, Latvia,
Lithuania, Malta, Poland, Slovakia, Slovenia, Norway, Iceland, Liechtenstein, Switzerland, Bulgaria and
Romania.

2. NON-EUROPEAN ECONOMIC AREA APPLICANTS WHO RESIDE WITHIN THE STATE.

In order that we can process your application it will be necessary for you to provide the HSE with the
relevant documentation showing you have permission to be in this state and have the relevant work
permit/visa/authorization required to be employed within this state.

3. For more details on EEA countries please visit the Department of Jobs, Enterprise and Innovation website
[Link]

Please provide details of Work Permit/Visa/Authorization below

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4. Superannuation Schemes

Are you currently in receipt of a pension from any of the following superannuation schemes?

YES NO

1. Local Government Superannuation Scheme (LGSS)

2. Health Service Executive Employee Superannuation Scheme

3. Voluntary Hospital’s Superannuation Scheme (VHSS)

4. Nominated Health Agencies Superannuation Scheme (NHASS)

If you have answered ‘yes’ in relation to any of the above Superannuation Schemes you are not eligible to apply
for this recruitment campaign. Former Health Service and public sector employees must ensure that they adhere
to their contractual obligations where they have previously availed of the Incentivised Scheme of Early
Retirement (ISER), 2010 Voluntary Early Retirement Scheme (VER)

5. Current Contractual Status

 I am currently a HSE employee* Yes No

Please tick the HSE Area in which you work

Dublin Mid Leinster South

Dublin North East West

If you answered yes to the above question, please choose the option below which best matches your current
contractual status:
 I have a permanent contract
or
 I have a temporary contract

*HSE Employee = you are a direct employee of the HSE and not in a post funded or partially funded by the HSE

What is your current employment title?

Current Grade/ Level as per Consolidated Pay Scales e.g. Senior

Physiotherapist, Clinical Nurse Manager 2, Clerical Officer
Grade III etc.

Date of your appointment to this post

6. Proficiency in Irish

Candidates will be afforded the added opportunity to demonstrate their ability to perform the duties of the office
through Irish. This assessment will be on a pass/fail basis and will not disturb the marks awarded in the
selection process. Where vacancies arise for which proficiency in Irish is a management requirement, the HSE
will offer such posts in order of merit to candidates who have successfully passed the Irish assessment. Please
indicate if you wish to undertake an Irish assessment exam Yes / No

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 QUALIFICATIONS & ELIGIBILITY CRITERIA

1. Please indicate below how your qualifications and professional experience meet the eligibility
criteria for the post of Clinical Nurse/Midwife Manager 1. Please note that if you omit information in
this section pertinent to the eligibility criteria you will be deemed ineligible and subsequently not
called forward to interview. Please complete each section below.

(i) Registered Nurse on the active Register of Nurses and Midwives held by An Bord
Altranais agus Cnáimhseachais na hÉireann (Nursing and Midwifery Board of Ireland) or be
eligible to be so registered.

Registration Please tick as appropriate Pin Number

to your current
Registration status
I am a fully qualified General Nurse with active An Bord Altranais
agus Cnáimhseachais na hÉireann (Nursing and Midwifery Board
of Ireland) registration
I am a fully qualified General Nurse registered with a European
Authority other than An Bord Altranais agus Cnáimhseachais na
hÉireann (Nursing and Midwifery Board of Ireland)
I am a fully qualified General Nurse registered with a non
European Authority
I am a fully qualified General Nurse who is eligible to be
registered with An Bord Altranais agus Cnáimhseachais na
hÉireann (Nursing and Midwifery Board of Ireland)

Seeking registration with Bord Altranais agus Cnáimhseachais na hÉireann (Nursing and Midwifery Board of
Ireland) is the responsibility of the applicant.

AND

(ii) Have a minimum of 3 years post registration full time experience (or an aggregate of 3 years
full
time experience) in the General division of the register.

Please indicate a minimum of 3 years post registration full time experience (or an aggregate of 3
years full time experience) in the General division of the register. Please note that you must have
achieved this experience no later than the closing date. Please detail below (in months) your
experience to date that demonstrates your fulfilling of the above eligibility criteria. 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 as they are. Please do not make
whole time equivalent calculations.

From Date To Date Average Total Employer Title of Post

00/00/00 00/00/00 Monthly Months
Hours

Total Cumulative Months

If it is not clearly evident from the title of your post that it satisfies the eligibility criterion for Clinical
Nurse/Midwife Manager 1, please provide further details in the box below.

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 AND

(iii) Have a minimum of 1 years’ full time experience (or an aggregate of 1 years full time
experience)
in the specialist area of Gynaecology.

Please indicate a minimum of 1 years’ full time experience (or an aggregate of 1 year’s full time
experience) in the specialist area of Gynaecology.
Please note that you must have achieved this experience no later than the closing date. Please detail
below (in months) your experience to date that demonstrates your fulfilling of the above eligibility criteria.
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 as
they are. Please do not make whole time equivalent calculations.

From Date To Date Average Total Employer Title of Post

00/00/00 00/00/00 Monthly Months
Hours

Total Cumulative Months

If it is not clearly evident from the title of your post that it satisfies the eligibility criterion for Clinical
Nurse/Midwife Manager 1, please provide further details in the box below.

AND

(iv) Demonstrate evidence of continuing professional development.

Please indicate evidence of continuing professional development in the box below.

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 ADDITIONAL EDUCATIONAL ACHIEVEMENTS

Please include second level and third level educational achievements:

Dates Educational Conferring Body Course of Study Qualification Grades

Institution Achieved Achieved
From
MM/YY
To
MM/YY

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DETAILED CAREER HISTORY – listing the most recent first

Overview of Career History. Please detail all periods since you have left full time education.
From To Title Employer

Job Title:

Grade/ Management Level (if applicable):

Employer(s) & Department Name:

From (00/00): To(00/00/) :

Main Roles & Responsibilities:

Job Title:

Grade/ Level (if applicable):

Employer(s) & Department Name:

From (00/00): To(00/00/) :

Main Roles & Responsibilities:

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Job Title:

Grade/ Level (if applicable):

Employer(s) & Department Name:

From (00/00): To(00/00/) :

Main Roles & Responsibilities:

Job Title:

Grade/ Level (if applicable):

Employer(s) & Department Name:

From (00/00): To(00/00/) :

Main Roles & Responsibilities:

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 Supplementary Questions 1 - 4
A guide to completing supplementary questions is available in Appendix 1 of this application form. It is strongly
recommended that you read the guide before completing this section of your application form.
In the spaces below, briefly describe what you consider to be a good example of demonstrating your ability in each
of the skill areas 1- 4. A summary definition of each skill area is provided for your information. This is a summary of
what we mean by each skill heading. Please provide the information in the format requested at (a), (b), and (c) on the
“Information on completing the Supplementary Questions” Section. Remember anything you say may be used as
part of a shortlisting/ranking exercise and may be discussed in more depth at interview, should you be called to one

1. Organisation and Management Skills

It is important that the Clinical Nurse/Midwife Manager 1 demonstrates Evidence of effective organisational skills
including awareness of appropriate resource management. S/he has the ability to attain designated targets,
manage deadlines and multiple tasks. S/he has ability to be self-directed, work on own initiative. S/he
demonstrates a willingness to be flexible in response to changing local/organisational requirements.

In the space below, please give an example of a situation where you best demonstrated your ability in this area.

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2. Building and Maintaining Relationships including Leadership, Managing People and Team Skills

The effective Clinical Nurse/Midwife Manager 1 has the ability to work independently as well as part of a wider
healthcare team; building and maintaining relationships and understanding and valuing individuals and their
respective roles. S/he identifies and builds relationships and influences key stakeholders. S/he maintains open
communication channels with team members and others as appropriate. S/he reacts constructively to setbacks and
is able to both give and receive feedback. S/he uses diplomacy and tact in fraught situations and can diffuse tense
situations comfortably.

In the space below, please give an example of a situation where you best demonstrated your ability in this area.

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3. Commitment to Providing a Quality Service

An effective Clinical Nurse/Midwife Manager 1 demonstrates a commitment to providing a quality service. S/he is
innovative and open to change in striving to ensure high standards in service delivery. S/he ensures that all service
users are treated with dignity and respect and makes certain that the welfare of the service user is a key
consideration at all times. S/he monitors and reviews his/ her own work, and that of the team to ensure its quality
and accuracy.

In the space below, please give an example of a situation where you best demonstrated your ability in this area.

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4. Professional Knowledge / Experience Relevant To The Role – Post Specific Requirements

Please indicate below how your experience meets the requirements of the post. This section will be assessed by a
board of Senior Managers to consider your experience as it is relevant to the post.
Short listing may occur based on the information provided here and in the other areas of this application form.
Please complete each section below.

Please include dates i.e. from x date to x date, the name of the employer /department you worked in.

Date(s) from – Date(s) to Employer(s) & Department Name

Demonstrate depth and breadth of experience in the area of Nursing/Midwifery as relevant to the role

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General Declaration

It is important that you read this Declaration carefully and then sign it in the space below.

Part 1: Obligations Placed on Candidates who participate in The Recruitment Process.

The Public Service Management (Recruitment and Appointments) Act 2004 makes very specific provisions in
relation to the responsibilities placed on candidates who participate in recruitment campaigns and these are
detailed in Section 4 of the Code of Practice issued under the Act.

These obligations are as follows:

Any canvassing by or on behalf of candidates shall result in disqualification and exclusion from the recruitment
process. Candidates shall not:
 knowingly or recklessly make a false or a misleading application
 knowingly or recklessly provide false information or documentation
 canvass any person with or without inducements
 impersonate a candidate at any stage of the process
 knowingly or maliciously obstruct or interfere with the recruitment process
 knowingly and without lawful authority take any action that could result in the compromising of any test
material or of any evaluation of it
 interfere with or compromise the process in any way

Any person who contravenes the above provisions, or who assists another person in contravening the above
provisions, shall be guilty of an offence.

It is the policy of the HSE to report any such above contraventions to An Garda Siochana.

In addition, where a person found guilty of an offence was or is a candidate at a recruitment / selection process,
then, in accordance with the Public Service Management (Recruitment and Appointments) Act 2004.

 where he / she has not been appointed to a post, he / shall be disqualified as a candidate; and
 where he / she has been appointed as a result of that process, he / she shall forfeit that appointment

Part 2
Declaration: “I declare that to the best of my knowledge and belief there is nothing in relation to my conduct,
character or personal background of any nature that would adversely affect the position of trust in which I would
be placed by virtue of my appointment to this position. I hereby confirm my irrevocable consent to the Health
Service Executive to the making of such enquiries, as the Health Service Executive deems necessary in respect
of my suitability for the post in respect of which this application is made.

I hereby accept and confirm the entitlement of the Health Service Executive to reject my application or terminate
my employment (in the event of a contract of employment having been entered into) if I have omitted to furnish
the Health Service Executive with any information relevant to my application or to my continued employment with
the Health Service Executive or where I have made any false statement or misrepresentation relevant to this
application or my continuing employment with the Health Service
Executive.

Furthermore, I hereby declare that all the particulars furnished in connection with this application are true, and
that I am aware of the qualifications and particulars for this position. I understand that I may be required to
submit documentary evidence in support of any particulars given by me on my Application Form. I understand
that any false or misleading information submitted by me will render me liable to automatic disqualification or
render me liable to dismissal, if employed.”

Failure to sign application will render it invalid1.

Signed: __________________________(Name of Applicant) Date: _____________________

REFERENCES

1
If you are submitting your application form via email we will accept the application form unsigned but you will be
required to sign the Declaration at interview should you be invited to one.

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Please give three referees (including your current employer). Please ensure that the referees you provide are
from a professional perspective. We retain the right to contact all previous employers.

Do you wish us to contact you prior to contacting your referees? Yes / No

1. Name and Job Title of Referee:

Dates From-To (MM/YY- MM/YY):

Professional Relationship to Candidate:

Postal Address:

Telephone Contact Details: Mobile: Landline:

Email Address:

2. Name and Job Title of Referee:

Dates From-To (MM/YY- MM/YY):

Professional Relationship to Candidate:

Postal Address:

Telephone Contact Details: Mobile: Landline:

Email Address:

3. Name and Job Title of Referee:

Dates From-To (MM/YY- MM/YY):

Professional Relationship to Candidate:

Postal Address:

Telephone Contact Details: Mobile: Landline:

Email Address:

Appendix 1
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SUPPLEMENTARY QUESTIONS GUIDE

Information on completing the Supplementary Questions:

In the supplementary questions section, you are required to describe some of your personal achievements to
date that demonstrate certain necessary skills and qualities required for the position. The skills and qualities are
outlined in the Questions Areas 1 – 4.

All question areas must be completed and remember that you will be questioned on all areas at interview. The
instructions below will help you to complete your answers, but you should also consider these instructions when
you are preparing for interview.

For each Question Area 1-4, you are given a description of a skill or quality. You are then asked to describe a
situation, from your own experience, which you think is the best example of what YOU have done which
demonstrates this skill or quality. It is essential that you describe how you demonstrated the skill or quality in
question.

The information you present here may form part of a ranking exercise process, and may also be used to help
structure your interview, if you are invited to one. A ranking exercise may apply based on the information you
provide in your application form. This means that a ranking board will “rank” applicants based on information put
forward in the supplementary questions section of your application form. Interviews may be held on a phased
basis, inviting applicants to interview based on the position held in the ranking exercise. A primary panel will be
formed of candidates successful in the first phase of interviews. If subsequent interviews are held candidates
successful at these interviews will be added to the end of the primary panel and will be listed with a lower order
of merit.

Therefore, compose your replies carefully in this section and try to structure what you write so that you give
specific information about what you have done - for example, do not simply say that “X was successful”, describe
exactly what you did and how you demonstrated the skill or quality in question.

Do not exceed the space allowed in the boxes. One of the key skills required of the post is the ability to write
clearly and concisely and your written communication skills will be assessed against what you write on
your application form.

For each example please include the following:

(a) the nature of the task, problem or objective;

(b) what you actually did and how you demonstrated the skill or quality (and, where appropriate, the
date you demonstrated it);
(c) the outcome or result of the situation and your estimate of the proportion of credit you can claim
for the outcome.

Please do not use the same example to illustrate your answer to more than two skill areas.

Please note that, should you be called to interview, the board may look for additional examples of where you
demonstrated the skills required for this post so you should think of a number of examples of where you
demonstrated each of the skills.

Notes:
 You may use a word processor to reproduce these pages and type your replies
 It is recommended that you keep a copy of this section of the application form

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Guidelines for Completing the Supplementary Questions

Supplementary Questions are designed to help you to present relevant evidence in order that decision makers
can evaluate how well you ‘fit’ the requirements of a particular role. Relevant evidence is usually drawn from
your work experience and the way in which you have accomplished a range of activities. Those involved in
screening the applications will be evaluating the information you give against specific skills required for
effective performance in the role. To do this they need you to give enough detail so that they can tell what you
actually did and how you did it.

The people doing the screening will not assume that you demonstrate a skill at the right level just because of
your current role, length of experience or educational qualifications. These do not give enough evidence about
how you accomplished relevant tasks.

So, if a question is about your approach to decision making, you need to do more than describe your current role
and list important decisions you have made. You will need to describe how you reached relevant decisions.

Some guidelines for presenting yourself well are given below:-

 Give specific examples – most questions will ask you to describe an example of when you have
demonstrated a skill: try to do this concisely but with enough detail so that the reader will be clear about
what you actually did. This detail might include information about timescales, the number of people
involved, budgets etc. It can help to use bullet points to that the sequence of events is clear to the reader.
 Give a range of examples – if possible, base your answers on different situations or challenges you
faced rather than rely on just one experience. This helps the reader to evaluate how you tackle different
challenges and not just your behaviour in a ‘one off’ situation.
 Be concrete rather than theoretical – a clear description of how you actually behaved in a particular
situation (and why) is of much more use to the reader than a vague or general description of what you
consider to be desirable attributes.

Examples on how to complete this section of the application form

Skill Area: Communication Skills: able to adapt your communication style to particular situations and
audiences….. able to produce clear and concise written information….

Example 1: I was responsible for producing important management reports and supporting presentations for a range of
important and high profile clients. Through my understanding of the clients’ needs and my effective communication skills, I
have ensured that the reports that go to the clients are relevant and focused, and are continually improved. The reports I
have produced and the presentations I have made were well received by all my clients. As a result of the combination of my
analytical thinking and interpersonal and communication skills, my brief has been extended to lead the development of the
strategic plan for the organisation.

Example 2: (a) The unit I was attached to was responsible for producing a management report and supporting oral
presentation for several large clients, some with significant problems and issues to report. In some cases the management
report was publicly available and was subject to a great deal of scrutiny. A new style/format of management letter needed to
be developed for my clients, as many of the clients were complaining that the letters were too large/long and difficult to read.

(b) I was tasked with developing a new style of management letter for the clients. I had to meet stringent quality
requirements/criteria whilst addressing the need to reduce its size. Following consultation, mainly over the phone and face-
to-face, with the majority of our clients, I realised that a summarised report format with a better visual and more interactive
presentation was the answer. I developed a format for a summarised report, reducing the average length from 40 pages to
just 10. I achieved this through careful editing of information and increased use of graphs etc. I then developed a more
focused presentation to clients and included more graphical displays and incorporated short presentations by colleagues
directly involved in producing the work. During the presentations I encouraged clients to ask questions and develop their
understanding of the issues at hand.

(c )The summarised management report and improved presentations were seen as a success by the clients, who with
exception, in responding to an evaluation survey, found the new format/style better than the previous, and all requested that
the revised system should be continued. 80% credit

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Example 1 (above):

This is not a good example because it:

- does not give sufficient details of exactly what the person did or how they actually demonstrated their “
effective communications skills”

- also, it is not clear where the information requested at (a), (b) and (c) (supplementary section) is
presented.

EXAMPLE 2 (ABOVE):

This is a better example because it:

- describes exactly what the person did and how they communicated, for example
“…..consultation, mainly over the phone and face-to face” & “developed a format for a summarised
report, reducing the average length from 40 pages to just 10” “achieved this through careful editing of
the information and increased use of graphs”. “encouraged clients to ask questions”

- also, it is clearer where the information requested at (a), (b) and (c) of the supplementary question section
is presented.

Reminder:

Once you have completed Question Areas 1-3, you should progress to Question Area 4 - a Knowledge
/ Experience Question. Please note that all 4 areas must be completed at the time of application.

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