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Gorey Application Form
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Gorey Application Form
Surname
*
Last
Name
*
First
Address
*
Address Line 2
Town
*
County
*
Phone
Email
*
Date of Birth
*
Mothers Maiden Name:
Nationality
Sex
Male
Female
PPS No:
*
Do you have a medical card?
*
yes
no
Please Attach Passport Size Photograph Here: (Optional - Please forward passport photo to plc office)
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Course Title and Code:
First Choice
Second Choice
Section 2: Previous Education Record
Junior Certificate
Junior Certificate Only
Year
Leaving Certificate
Ordinary
LCVP
LCA
Year
Fetac Level
3
4
5
6
Year
Hetac Level (6-10)
Yes
No
Year
Other Please Specify
No Prior Qualification
Tick if appropriate
If you are sitting your Leaving Certificate this year please state name of School:
Status Last September
At School
Training
Employed
Full Time
Part Time
Uemployed
0-6 months
6-12 months
12 months or more
other
Health & Disability: Please state if you have any health/disability problems. This information will remain confidential to College authorities and the Course Director.
NON EU NATIONALS please contact the College re fees payable.
ENGLISH IS MY FIRST LANGUAGE: please tick one
yes
no
Where English is not a first language applicants will be required to have a working knowledge of written and spoken English.
Section 3: Please supply the name and contact details of two referees:
Reference 1
Name
Address
Phone No:
Position
Reference 2
Name
Address
Phone No:
Position
Section 4:
How did you hear of Gorey PLC?
Guidance Counsellor
Friends
P.L.C./F.E. Co-ordinators visit to school
E.V.C. Open Day
Career Exhibition*
Local News paper*
Internet
Past Student of EVC
*Which one(s)?
Other - Please Specify
I give consent for the transmission of personal data to the SOLAS for statistical purposes
*
yes
I understand that I must inform Enniscorthy Vocational College (a) if I have a criminal record and (b) if I was, am or will be involved in any court case.
*
yes
If admitted to the college I agree to accept all the college regulations including the procedures on criminality and Further Education students.
*
yes
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