NDNTP Application Form Payment

PERSONAL INFORMATION

Your personal information is required in order that we can properly assess your suitability for this course. Your personal data is very important to us and we will only share it with the course applicant assessors. We will take all technical and organisational measures necessary to protect your personal data in accordance with the General Data Protection Regulation, 2018 and the Data Protection Act, 2018. Your data will be retained in accordance with our data retention & destruction policy.

First name

Surname

Date of birth

Email address

Confirm email address

Telephone number (mobile)

Address 1

Address 2

Town

County

Eircode/Postcode

EMPLOYER DETAILS

Name of current employer (first name and surname of supervising dentist)

Employer's Address 1

Employer's Address 2

Employer's Town

Employer's County

Employer's Eircode/Postcode

Work telephone number

Employer's Email address

Confirm email address

Main duties

Date of commencement of employment with the above employer

Employment status

Place of employment

How many hours a week do you normally work? You must work a minimum of 30 hours per week to be eligible to apply for the programme. Please note that should you work between 25 and 30 hours per week, it may take longer than 16 months to complete the programme. For further information, please contact the Nursing Administrator at DentalNurseTutor@dental.tcd.ie

EDUCATION

Title of Secondary Level Education certificate received

Have you completed a Basic Life Support for the Healthcare Provider Course in Cardio-Pulmonary Resuscitation (CPR)?

ADDITIONAL INFORMATION

Using this space, please tell us why you should be considered for a place on this programme

How did you hear about this programme?

Practitioner

Previous graduate

Journal of the Irish Dental Association

Irish Dental Nurses Association

Other journal or magazine

Other (please specify)

DECLARATION

I certify that the information provided in this application form is accurate and true to the best of my knowledge. I understand that providing incomplete or false information may result in my application not being processed.

I understand that I must have access to a computer and internet access (high speed/broadband access is preferred) to enable daily access to the programme website.

Please confirm by choosing yes, that you have read and understood the Application Process and Course Outline document. This is posted on the front page.

Please confirm by choosing yes, that you have discussed this programme with your Dental Practitioner and have made him/her aware of time commitment needed.

Please confirm by choosing yes, that you have good computer skills.

I confirm the details of the employing /supporting dental practitioner declared in the application documents are correct and will be valid up to andincluding commencement of the programme at the end of August.

It is important that all pages of the Supporting Documentation (this is available at the end of the NDNTP information page – see the 'Applications' area) are completed and submitted below.

Please scan and UPLOAD each document below. Paper applications will not be accepted.

Signed ‘Practitioner Declaration of Support’ (this document is included in the Supporting Documentation package, available from the NDNTP information page on the website). PDF or JPG documents accepted. Word documents not accepted.

Completed ‘Verification of Experience’ (this document is included in the Supporting Documentation package, available from the NDNTP information page on the website). Each supervising dental practitioner for which you are employed must sign this. PDF or JPG documents accepted. Word documents not accepted.

Completed ‘Self-evaluation Form’ and signed by the supervising dental practitioner (this document is included in the supporting documentation package, available from the NDNTP information page on the website). PDF or JPG documents accepted. Word documents not accepted.

Tick each box below to confirm:

I understand that my application is not complete and it WILL NOT BE REVIEWED, until i) the online application form is completed in full, ii) the administration fee is paid and iii) a copy of each of the above documents are supplied to the Dublin Dental University Hospital via this online form.

If successful at the first stage of the application process and as a condition of a place on the programme, I understand that I must provide a laboratory copy of the following blood tests:

Proof of non-infection with Hepatitis B. This must be dated within 6 months.
Proof of non-infection with Hepatitis C. This must be dated within 6 months.
Proof of Hepatitis B immunity. The result must be greater than 10mIU/mL

Please wait until you are requested to send the blood test results. These will be sent confidentially and directly to the Dental Nurse Tutor and not via this on-line process.