Last Name: Postal address for correspondence: MOBILE TELEPHONE (mandatory): Contact Tel No. 2: E-mail Address (mandatory): PPS Number (mandatory): Drivers Licence (please state type & category): European Economic Area Are you an EEA (European Economic Area) National? Yes / No NB If you are a non EEA citizen you must provide the requested documentation to support your application. To help us gauge the efficiency of our advertising strategy for this campaign, the HSE would appreciate it if you indicated in the table below where you saw this campaign advertised. ++ More than one indication is allowed. Superannuation Schemes Are you currently in receipt of a Voluntary Early Retirement or Ill Health Early Retirement Pension from any of the Public Health Superannuation Schemes listed at 1-5 below, or any other Public Sector Pension Scheme? Are you currently in receipt of a pension from any of the following superannuation schemes? (This have you retired?) YES NO Local Government Superannuation Scheme (LGSS) Health Service Executive Employee Superannuation Scheme Voluntary Hospital’s Superannuation Scheme (VHSS)
Last Name: Postal address for correspondence: MOBILE TELEPHONE (mandatory): Contact Tel No. 2: E-mail Address (mandatory): PPS Number (mandatory): Drivers Licence (please state type & category): European Economic Area Are you an EEA (European Economic Area) National? Yes / No NB If you are a non EEA citizen you must provide the requested documentation to support your application. To help us gauge the efficiency of our advertising strategy for this campaign, the HSE would appreciate it if you indicated in the table below where you saw this campaign advertised. ++ More than one indication is allowed. Superannuation Schemes Are you currently in receipt of a Voluntary Early Retirement or Ill Health Early Retirement Pension from any of the Public Health Superannuation Schemes listed at 1-5 below, or any other Public Sector Pension Scheme? Are you currently in receipt of a pension from any of the following superannuation schemes? (This have you retired?) YES NO Local Government Superannuation Scheme (LGSS) Health Service Executive Employee Superannuation Scheme Voluntary Hospital’s Superannuation Scheme (VHSS)
App%20form%20Temp%20OT%20Manager%20in%20Charge%20III%2C%20GUH%20v1.docx