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Employment Confirmation Certificate - Excel by tkx61813

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									         INCREMENTAL TEACHER APPOINTMENT AND                                                                   FORM S/CC
                     RE-APPOINTMENT FORM
                                                       ~ PART 1 ~

Roll No                                                                 SCHOOL YEAR:

School:

Address:

E-mail:                                                                           Telephone No:

TEACHERS PERSONAL DETAILS

Teacher's PPS No.                                                                 Payroll No.
(Compulsory for salary)                                                           (if known)


Title:                             Gender: Male                Female                          Lay or Religious (L/R)

Surname:                                                   First Name(s)

Please indicate if you ever changed your name: (e.g. on marriage or by deed poll)

Former name _________________________________                           Date changed

Permanent Home Address:


Date of birth:                                                      Contact Telephone No:
(verified from full birth cert.)                                    Mobile Number:

                                                                    E-mail:

Is teacher non-EU citizen?                        Yes/No

If 'Yes', is copy of work permit retained in school?                          Yes/No (if 'No' teacher is not eligible for salary)

New Entrant:              Yes:         No:             Please refer to Circular 09/04

EMPLOYMENT DETAILS
                  Wholetime                                                                       Part-time      Hours     Minutes

Permanent:                         Fixed Term Wholetime                       Permanent:
                                   Hours     Minutes                                                   Hours     Minutes
CID:                                                                RPT Contract(s)

Date of Appointment:

If a Permanent/CID appointment, is it within 95% of initial teacher allocation?                        Yes/No or N/A
(Community & Comprehensive Schools Only)


Origin of the post __________________________________________________________
   e.g. Replacing Retirement(Compulsory/Voluntary/Disability)/Resignation/Jobshare/Career Break Replacement
     (New Post because, projected enrolment/curricular concession/special needs/non nationals/travellers)
       Secondment/Death/Other(State Reason)


Post to which teacher is being assigned: _________________________________________
   e.g. Subjects Teacher/Principal/Deputy Principal/Other, Please specify
                                                   ~ P A R T 1 ~ (Continued)
              (need not be completed if being re-appointed in the same school unless the account details have changed)

                                BANK DETAILS FOR LODGEMENT OF SALARY:

       Bank Name:
       Bank Address:


       Full name in which
       A/C is held:

                           A/C No:                                               Bank Sort Code:
NB     Please ensure your Bank Account is within the Republic of Ireland and will support the Electronic
       Money Transfer System

                                                   ~ PART 2 ~
Registration details of proposed teacher:

(1) Is the proposed appointee currently registered with the Teaching Council?                            Yes/No

(if 'No', Appointment form should not be completed and proposed appointee must be referred to the
 Teaching Council)

(2) Registration number:                                             Registration date:

(3) Category of registration:        (Please tick appropriate box)


Full                  Conditional             Expiry date:                                           Non-Qualified
                                              Must be completed if conditional


(4) Has the proposed appointee been vetted, where relevant?                                 Yes/No
(Refer to Circular 0094/2006)

(5) If Gaeltacht\all Irish school does teacher hold Irish Qualification as per Circular 22 / 00                           Yes/No
        If 'Yes', copy of qualification must be attached
        If 'No' teacher may be appointed as RPT only for 1 year and post must then be re-advertised

(6) Have you received confirmation of fitness to teach in respect of the proposed appointee from the
  Occupational Health Service?                     Yes/No

  ( If No, appointment form for this teacher should not be completed until confirmation is received)

                                                               Year of                      Please tick appropriate box
(7) Degree:___________________________________                 Award:_____________          Pass:             Honours:

University/College:_________________________________

PLEASE ATTACH COPIES OF TEACHER'S PARCHMENT(S) AND TRANSCRIPT'S OF RESULTS FOR EACH
YEAR OF DEGREE (This is necessary to verify the category of allowance paid) and copy of the
Certificate/Confirmation of Registration from the Teaching Council

                                                  Year of                                   Please tick appropriate box
(8) Teacher Training:_____________________________Award:_____________                       Pass:             Honours:

University:___________________________________

(PLEASE ATTACH COPIES OF TEACHER'S PARCHMENT(S) AND TRANSCRIPT'S OF RESULTS)

(9) Other Qualifications:_________________________________________                           Year of Award:___________

University:___________________________________
                                     ~ P A R T 3 ~ (need not be completed if being re-appointed in the same school)
                                    TO BE COMPLETED BY PROPOSED TEACHER

PREVIOUS TEACHING SERVICE


                                          PERMANENT WHOLE-TIME SERVICE
FROM                                TO                   SCHOOL NAME AND ADDRESS




                                          TEMPORARY WHOLE-TIME SERVICE
FROM                                TO                   SCHOOL NAME AND ADDRESS




                                          REGULAR / ELIGIBLE PART-TIME TEACHER SERVICE
FROM                                TO                   SCHOOL NAME AND ADDRESS




N.B. If you have previous service you may be entitled to incremental credit - see 'Notes to New Appointees' which is
available from your Principal


If your previous service was in a V.E.C. school then a statement of service from the relevant V.E.C. is required




Name and address of employment
immediately prior to this appointment:

Date of cessation of employment:                                                      P45 ENCLOSED                     Yes/No


Are you currently in receipt of pension from the Department of Education or any V.E.C.?                            Yes/No

If 'Yes', please give details of pension i.e. voluntary, disability, early retirement strand, compulsory:




Please tick if you would like to receive your correspondence through Irish:
                                          ~ PART 4 ~


              FORM OF AUTHORISATION (SICK / MATERNITY PAY)
                      (TO BE READ AND SIGNED BY ALL NEW TEACHERS)



I have read and understand the conditions and procedures involved in the operation
of the sick/maternity pay schemes applicable to temporary and permanent second-
level teachers. I am aware that depending on my PRSI contribution record I may be
entitled to payment from the Department of Social and Family Affairs in respect of
absences under these schemes. I acknowledge that payment from the Department of
Education and Science during absence on sick/maternity leave (including absences
rising from an occupational injury or disease) will be subject to the following
conditions:

(a)    that I will authorise the Department of Social and Family Affairs to pay any
       benefit due to me in respect of such absences under the social insurance
       system directly to the Department of Education and Science;

(b)    that I will make the necessary claims for social insurance benefit to the
       Department of Social and Family Affairs within the required time limits and
       will, to the best of my ability, comply with whatever requirements are laid
       down by that Department as a condition of claiming benefit.

I also acknowledge that any payments made to me by the Department of Education
and Science in respect of such absences may be recovered from me in the event that I
fail to comply with the foregoing conditions.

Accordingly, I accept that in order to ensure compliance with the above undertaking
and the sick/maternity leave regulations, the Department of Education and Science
may be required to make direct contact with the Department of Social and Family
Affairs to establish what payments were made to me, when they were made and the
amount and duration of such payments. I hereby authorise the Department of
Education and Science to make such enquiries. I understand that any information
obtained from the Department of Social and Family Affairs will be used only for the
foregoing purposes and will not be disclosed to any unauthorised person.

I hereby authorise the Department of Social and Family Affairs to pay any social
insurance benefit due to me in respect of any future absences from duty on
sick/maternity leave (including absences arising from an occupational injury or
disease) directly to the Department of Education and Science.


Signed:                                        Date:

PPS No:                                        School Roll No:



 Note: This form should be completed, on initial appointment, by second-level
teachers who will be paying PRSI Class A.
Salary will not be payable unless a signed mandate is returned with the appointment
form.
                                                    ~ PART 5 ~

Declaration by School Manager/Principal:

I certify that:-
Tick:
        (a) I have completed relevant sections in this document and the detail therein is true and accurate



        (b) I have received confirmation of fitness to teach in respect of the proposed appointee from the
          Occupational Health Service

        (c) I have examined the original Certificate/Confirmation of Registration, Transcript of Results
           (for each year of study) and Parchments/Certificates of the qualifications held by this teacher.
            I have signed each enclosed copy of these documents, in respect of new appointee's only
            and confirm they are true copies.

        (d) A written contract of employment has been signed by both parties, this contract is held in this
            school and a copy has been given to the teacher.

        (e) I accept that it is the responsibility of the school authority to ensure that this form is correctly
           completed in order for salary and allowances to be paid to the appointee.


Signed:                                                                          Date:______________________
                   Manager/Principal




                                                         ~ PART 6 ~

Declaration by teacher:

I certify that:-
Tick:
        I the undersigned declare that the information recorded in this document is true accurate and complete
        in all respects.

        I declare that any external work engaged in by me must not be such as to interfere
            with the fulfilling of my duties and responsibilities to the school.

        I am not in receipt of a pension from the Department of Education or any V.E.C.

        I am currently registered with the Teaching Council

        I have read the contract of employment and shall abide by the terms.


        I understand that if this document is returned incomplete I will not be paid salary

        I have signed the mandate form (Part 4, Form of Authorisation (sick/maternity pay))


        Teachers signature:                                                                   Date:

								
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