ESF+ SKILLS CONNECT APPLICATION FORM (Summer 2025)
Please complete in order to be assigned to interview for LHP Skillnet's Healthcare Support Course (QQI Level 5, Major Award). Please make sure your answers contain no errors. If you pass your interview and we submit the wrong details to the Garda Vetting Bureau, the process will be greatly delayed.
Personal Information
PLEASE ENSURE YOU SPELL YOUR NAME CORRECTLY AS THIS SPELLING WILL BE USED ON CERTIFICATE AWARDED
First Name
*
Forename
Middle Name
*
Last Name
*
Surname
Email
*
example@example.com
EMAILS DO NOT MATCH
Confirm Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Home Address
*
Street Address
Street Address Line 2
Town/City
County
Eircode
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Date of Birth
*
-
Day
-
Month
Year
Date
PPSN
*
I will provide documentation to validate my identity as required and I consent to making this application in the knowledge that it will be processed by a third party organisation (the NRF) and to the disclosure of information by the National Vetting Bureau to the Liaison Person via that third party organisation (the NRF) pursuant to Section 13(4)(e) National Vetting Bureau (Children and Vulnerable Persons) Acts 2012 to 2016.
*
Yes
No
Back
Next
Save
Declarations
Please complete in order to be assigned to interview for LHP Skillnet's Healthcare Support Course (QQI Level 5, Major Award).
In order to participate on this course, it is a requirement to have Garda Clearance..
*
I confirm that I have never been convicted of a criminal offence in Ireland or in any other country and have no cases pending.
I have been convicted of a criminal offence and/or have cases pending.
If you have been convicted of a criminal offence and/or have cases pending, please explain the nature of the charge/s
*
What challenges, if any, do you feel you may have that could impact on your ability to successfully complete the academic aspects of this course? (examples dyslexia, English language, reading, writing, IT literacy or any social/personal issues etc.)
What supports do you feel could help you overcome these challenges?
Work placement is important for the completion of assessments for this programme. What challenges, if any, do you feel you may have that could impact on your ability to successfully complete the work placement aspects of this course? (examples injuries, medical conditions, comprehension, English language, availability, flexibility with days and times, childcare, transport etc.)
What supports do you feel could help you overcome these challenges?
I hereby consent to my data being used for the purpose of course administration which will involve my details being shared with LHP Skillnet staff, the contracted tutor(s) and QQI. I am aware that if I do not commence the course as allocated, or if I drop out without completing any modules, or are no longer on a course for any reason, that my details will be destroyed in line with data protection policy.
*
Yes
No
I hereby confirm that I am medically fit to undertake this course and the associated work placement.
*
Yes
No
I understand that a laptop or desktop computer is required for this programme and that a phone or tablet is not suitable. I confirm I am able to complete basic computer tasks and will have the use of a suitable device for the duration of the programme.
*
Yes
No
I confirm that I have the technical aptitude to use Microsoft Word, send and receive emails, and follow basic IT instructions.
*
Yes - I can meet the technical requirements
No - I can't meet the technical requirements
I also confirm that I will be in possession of a desktop or laptop that has both a webcam and microphone by the time the course begins and will have access to it for the duration of the programme.
*
Yes - I can meet the technical requirements
No - I can't meet the technical requirements
What We Use Your Personal Data For:
By booking a course or registering as a trainee you give consent to Leading Healthcare Providers Skillnet and Skillnet Ireland to collect and process personal data for the necessary legitimate interest of managing and delivering the course and in accordance with their privacy policy. Skillnet Ireland and Leading Healthcare Providers Skillnet will comply with all applicable Data Protection Legislation in the processing of this information. You understand that the data will be shared with Skillnet Ireland. The data will be used to provide the Department of Further and Higher Education, Research, Innovation and Science with statistical information only in aggregate format. You can view the Trainee Privacy Statement of Skillnet Ireland at: https://www.skillnetireland.ie/data-protection/ may also be shared with the training provider in order for them to communicate with the trainee in relation the training event.To read our privacy policy in full, visit: https://www.lhpskillnet.ie/website-privacy-policy/ You can withdraw your consent at any time by sending an email to office@lhpskillnet.ie
OneNote Import Completed
NO
YES
Sonrai Upload Completed
NO
YES
Newsletter Import Completed
NO
YES
Save
Submit
Should be Empty: