Personal Details

First Name *

Last Name *

Current Address Line 1 *

Current Address Line 2 *

Current Address Line 3

County *

—Please choose an option—CarlowCavanClareCorkDonegalDublinGalwayKerryKildareKilkennyLaoisLeitrimLimerickLongfordLouthMayoMeathMonaghanOffalyRoscommonSligoTipperaryWaterfordWestmeathWexfordWicklow

Eircode/ Postal Code

International code for mobile

Mobile Number *

Confirm Mobile Number *

Email Address *

Confirm Email Address *

Nationality

English Language Proficiency

Did you previously sit an IELTS/OET exam? *

—Please choose an option—YesNo

Eligibility Criteria

Only applicants who are in receipt of relevant documentation can apply. Please see FAQs.

Please select the statement that best matches your status: *

A Ukrainian citizen holding a professional qualification in health or social care resident in the State pursuant to the Temporary Protection Directive (2001/55/EC).A programme refugee holding a professional qualification in health or social care resident in the State.A recognised refugee and recipient of subsidiary protection pursuant to the International Protection Act 2015 who hold a professional qualification in health or social care.

Please select your Health and Social Care Profession *

—Please choose an option—DoctorDentalOther

GENERAL DECLARATION

It is important that you read this Declaration carefully.

Declaration: “I declare that to the best of my knowledge and belief there is nothing in relation to my conduct, character or personal background of any nature that would adversely affect the position of trust in which I would be placed by virtue of my selection for Clinical English language training. I hereby confirm my irrevocable consent to the College of Anaesthesiologists of Ireland (CAI)* to the making of such enquiries, as the CAI deems necessary in respect of my suitability for undertaking Clinical English language training in respect of which this application is made.

I hereby accept and confirm the entitlement of the CAI to reject my application if I have omitted to furnish the CAI with any information relevant to my application or where I have made any false statement or misrepresentation relevant to this application.

Furthermore, I hereby declare that all the particulars furnished in connection with this application are true, and that I am aware of the qualifications and particulars for Clinical English language training for my given discipline/ profession. I understand that I may be required to submit documentary evidence in support of any particulars given by me on my Application Form. I understand that any false or misleading information submitted by me will render me liable to automatic disqualification.”

I understand the above Declaration *

Please Enter Your Signature

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Signature is mandatory.

Failure to sign this declaration at application will render it invalid.

*The College of Anaesthesiologists of Ireland (CAI) are the body administrating the Clinical English Language training on behalf of multiple disciplines.

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