Application Form

Application form for Senior Academics

About the Vacancy

Job Reference Number

Job Title

Personal Details

Surname

First Name

Permanent Address

Contact Number

Email Address

Are you currently eligible to work in the Republic of Ireland?**

** Please note that you will be required to prove eligibility to work in the Republic of Ireland as part of the recruitment process as it is a condition of employment with DCU that employees must be eligible to work in the Republic of Ireland.

Employment History

Current Employer

Nature of Business

Position

Commencement Date

Description of Duties and Responsibilities

Current Salary

Benefits, Allowances and Pension Arrangements

PREVIOUS POSITIONS

From (MM/YY)	To (MM/YY)	Employer	Position	Reason for Leaving
From	To	Employer	Position	Reason for Leaving
From	To	Employer	Position	Reason for Leaving
From	To	Employer	Position	Reason for Leaving
From	To	Employer	Position	Reason for Leaving
From	To	Employer	Position	Reason for Leaving

Work Experience

How do you meet the required criteria?

Please outline further information that may help in assessing your application

Leisure time interests may be included here

Academic History

Have you obtained a PHD Qualification?

Year Awarded

Educational Institute

Subject

ACADEMIC QUALIFICATIONS

Higher Education Institute	From (MM/YY)	To (MM/YY)	Academic Qualification	Final Exam Result
Higher Education Institute	From	To	Academic Qualification	Final Exam Result
Higher Education Institute	From	To	Academic Qualification	Final Exam Result
Higher Education Institute	From	To	Academic Qualification	Final Exam Result
Higher Education Institute	From	To	Academic Qualification	Final Exam Result
Higher Education Institute	From	To	Academic Qualification	Final Exam Result

H INDEX

Please outline your H Index using Scopus

Research

Number of years full-time research experience

Number of years full-time teaching experience

Number of years experience working in an academic role

Number of years experience working in an professional or mixed role

Teaching Experience

Do you have teaching experience?

Level of Responsibility

Co-ordinated modules including module design?

Supported module delivery in a lecturing role?

Supported module delivery as a demonstrator/tutor?

Please provide a personal research statement

You may include details of key projects, collaborations and public engagements

List 3 key publications and outline whi they were impactful

Plans for Future Research

External Engagement

Please outline your professional experience

What experience do you have in academic service roles / external engagement beyond the University?

Outline infrastructure and/or support requirements

REFEREES

Referee Name	Job Title	Institution/Organisation	Email Address	Contact Number
Name	Job Title	Institution / Organisation	Email Address	Contact Number
Name	Job Title	Institution / Organisation	Email Address	Contact Number
Name	Job Title	Institution / Organisation	Email Address	Contact Number

Please list 3 persons from whom the University may request references on your behalf. They should be such as to be able to comment in details on your career. Applicants must include their present employer or past employer (if not currently employed)

PERIOD OF NOTICE

How soon after an offer of employment would you be in a position to take up employment?

ADVERTISING

Where did you see this position advertised?

DECLARATION

I certify that all statements on this application are true without omission and understand that any misstatement given disqualifies my application or may result in dismissal if employed by the University. I fully recognise that canvassing disqualifies my application.

PRIVACY NOTICE

I have read and understood the DCU Privacy Notice

COVER LETTER

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PUBLICATIONS / CONFERENCES

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