For office use only:

Attach passport sized photo here

Activity Leader/Summer Cara Application Form

Please send the following details with your application: A current Curriculum Vitae (CV/Resum) A Police Certificate from Country of Residence Irish/UK applicants please contact Barretstown One passport-sized photograph with signature on the back/3 photographs required from Non-EU Candidates Copy of any certificates/qualifications in support of application Two written references in English Names of two telephone referees (To be different from telephone referees) (Please note referees must not be friends, family members or relatives)

COMPLETE IN BLOCK CAPITALS

Title: Nationality: First Name: Male Female Surname: Are you over 18 years? Yes No

(Please tick)

(Please tick)

Current address: Town/City: County/State: Postal Code: Country:

Permanent address: Town/City: County/State: Postal Code: Country:

Telephone: (including country code)

Home: Mobile:

Work:

Email:

Relevant Experience in Support of this Application

Position Held: Organisation: Address: Role/Responsibilities: Employment Dates: From to

(Please continue on separate paper if you have additional voluntary experience not stated on your CV/Resume) What experience(s) has prepared you for the role that you are applying for?

Certificates
Do you hold any of the following certificates? (If YES, please tick complete Level and Expiry Date of Certificate) Beach Lifeguard or equivalent Level: Water Safety First Aid Level: Level: Expiry Date: Expiry Date: Expiry Date:

Languages
All Barretstown staff and volunteers must be FLUENT in English

Other Language:

Level: (e.g. Native Speaker/Conversational/Basic) Level: (e.g. Native Speaker/Conversational/Basic)

Other Language:

Only complete the following if you are applying for an Activity Leader position.

Therapeutic Recreation
Barretstowns programme is based upon a model of Therapeutic Recreation, in which each activity presents children with challenges. These challenges are met with success; the experience is reflected upon (through writing, discussion etc) leading to new discoveries about childrens self-worth, confidence, independence, etc. Listed below are the activity areas for Barretstowns programme: Archery* Arts & Crafts Camping Canoeing* High Ropes* Low Ropes* Equestrian* Fishing Nature Photography Pottery* Theatre *Preference shall be given to candidates with recognised qualifications in these areas. State activities you would be interested in leading, running and designing in column A, activities you could assist in leading in column B, and activities you would be interested in learning in column C.

Creative Writing Music

(A) Leading & Designing

(B) Assisting

(C) Would like to Learn

Indicate season(s) applying for

Spring

Summer

Autumn

Please give a description of your experience in the area(s) chosen in Column A (continue on a separate sheet of paper if required)

As an Activity Leader, you will also be involved in helping to design evening programmes. These are all-camp activities involving up to 100 children and lasting approximately one and a half hours. They are designed to engage, entertain and enhance socialisation, self-esteem, etc. Please outline a few ideas of what you might incorporate in to such an evening programme.

Telephone References
Barretstown reserves the right to contact the below named referees. These referees must know you, cannot be friends, family members or relatives and should have a good knowledge of English. 1. Name: (BLOCK CAPITALS) How does this person know you? 2. Name: (BLOCK CAPITALS) How does this person know you? Telephone Number: Telephone Number:

Have you ever had any licence, certificate or employment suspended, endorsed, revoked or terminated? Yes No If Yes, please provide details:

Are you at present, or have you in the past, been the subject of any investigation or has any action ever been taken against you with regards to a child/children under 18 years of age, or any other investigation, criminal or otherwise, whether or not resulting in acquittal or exoneration? Yes No If Yes, please provide details:

Are there any restrictions on you being able to work in Ireland, as far as you know? Yes No If Yes, please provide details:

How did you hear of Barretstown? Please specify:

If you wish to be excluded from receiving information about other Barretstown events or fundraising, tick this box.

I confirm, to the best of my knowledge, that the information contained in this application is correct and give my consent for Barretstown to contact the above named referees in order to obtain telephone references in support of my application. Signed: Date: Barretstown is an equal opportunities employer. Please return completed application form to: Staff Recruitment, Barretstown, Barretstown Castle, Ballymore Eustace, Co Kildare, Republic of Ireland Email: recruit@barretstown.org Tel: +353 45 864 115 Fax: +353 45 864 711 Website: www.barretstown.org