Form Hr 101 V4 PDF Details

The HR 101 V4 form, an essential document for managing personnel administration within organizations, plays a critical role in streamlining the onboarding process for new hires, rehires, and those transferred within the health services or related fields. This comprehensive form requires applicants to provide detailed personal information, employment history, and professional registrations, thereby ensuring a holistic approach to employee setup. Specific sections are dedicated to Personal Information, Next of Kin details for emergency situations, Employment History to scrutinize past affiliations with health services or public service employers, and whether the individual is receiving any form of pension under specified superannuation schemes. Moreover, the form delves into banking information for salary processing, professional registration for positions requiring official credentials, social insurance details, and qualifications, encompassing both academic and professional achievements. Also included are sections for assessing proficiency in the Irish language, crucial for roles requiring communication in Ireland's native language, and an employee declaration to affirm the accuracy of the provided information. The latter parts of the form, intended for completion by managerial or HR personnel, cover appointment specifics, contract terms, work patterns, and pay details, alongside pension eligibility, service years for annual leave determination, and requisite approvals for employment commencement. This meticulous documentation is pivotal in facilitating efficient human resource management, ensuring compliance with legal and organizational standards, and laying the foundation for transparent and effective employee relations.

QuestionAnswer
Form NameForm Hr 101 V4
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other nameshr101 hse, Superannuation, hr101, V4

Form Preview Example

if you have had multiple assignments with these employers please provide details of your latest employment)

Employee Set up form HR 101

This form is to be completed for all new entrants and forwarded to Personnel Administration.

Please complete in block capitals & place a tick  in the appropriate boxes

Hire

Re-hire

Internal HSE Payroll Transfer

 

Permanent

Temporary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Personnel Number

 

 

 

 

 

 

 

 

 

Start Date

D

D

M

M

Y

Y

Y

Y

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sections 1-9 should be completed by Employee.

1. Personal Information

 

Title

Mr

Mrs

Ms

Miss

 

Dr

 

Sr.

Rev.

 

 

Fr.

 

 

 

 

 

Prof.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Surname

 

 

 

 

 

 

 

 

First Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Known as

 

 

 

 

 

 

 

 

Initials

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Town/City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County

 

 

 

 

 

Post Code

 

 

 

 

 

 

 

 

 

 

 

 

Country

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone No

 

 

 

 

 

 

 

 

Mobile Phone No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Email address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Maiden Name

 

 

 

 

 

 

 

 

Nationality

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gender

Male

Female

 

 

 

 

 

Date of

 

 

 

D

 

 

D

 

 

 

M

M

Y

Y

 

Y

Y

 

 

 

 

 

 

Birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Marital Status

Single

Married Civil Partnership

Widowed Divorced

Separated Co-Habiting

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relevant certificate/s attached

Yes

No

 

 

 

 

PPS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Next of Kin (Emergency Contact Details)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Surname

 

 

 

 

 

 

 

 

First Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relationship to you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Town/City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County

 

 

 

 

 

Post code

 

 

 

 

 

 

 

 

 

 

 

Country

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact Phone No

 

 

 

 

 

Mobile Phone No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. Employment History

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are you Currently employed by HSE / Public Service

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If currently employed by HSE please provide details of your personnel

 

 

Personnel Number

 

Pay group / payroll

 

 

 

 

 

area

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

number and pay group/payroll area.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Were you previously employed by HSE / Health Board / Voluntary Hospital / National Hospital/ Public Service

 

 

 

Employer?

 

Yes

No

 

If No please go to section 4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If previously employed by HSE / Health Board / Voluntary Hospital / National Hospital please provide the following details. (Note:

Name of employer

 

Last Day of

 

service

 

 

Grade

 

Personnel

 

Number

 

 

D D

M M

Y

Y Y

Y

HR 101_V4 Sep 2012

Page 1 of 6

Revised 25/09/2012

If Faxing please ensure the employee’s Name and Personnel Number are included for each page of form

Name ____________________________ Personnel No.__________________________________

Are you in receipt of a pension under the Local Government Superannuation Scheme or HSE Superannuation

Scheme? Yes No

If Yes please provide information requested below

Name of Authority/

 

Start Date of

Employer

 

Payment

D

D

M M

Y Y

Y Y

4. Bank Details

Bank Name

 

 

 

 

 

 

Bank Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bank Sort Code

 

 

 

 

 

 

Account No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Payee Name

5 Professional Registration

Note: only applies to Medical & Dental, Health & Social Care Professionals & Nursing. If this section does not apply to you go to section 6. If you have multiple registrations please complete Appendix 1.

Name on

 

 

 

 

 

 

 

 

Issued

 

 

 

 

 

 

 

 

Registration

 

 

 

 

 

 

 

 

By

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of issue

D

D

M

M

Y

Y

Y

Y

Expiry

D

D

M

M

Y

Y

Y

Y

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Professional Registration / Membership Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. PRSI Details

PRSI Class:

Are you a Full Medical Card Holder?

Yes

No

 

Are you a GP Visit Card Holder?

Yes

No

Note: if you have answered yes to any of these questions

please attach supporting documentation from Dept of Social

Are you a widow / widower?

Yes

No

Protection (Social Welfare) or HSE

Are you a lone Parent?

Yes

No

 

 

 

 

 

7. Qualification Details

Note: Copy of Certificates to be attached

 

 

 

 

 

 

 

 

 

 

 

 

Official use only

 

 

Name of Qualification

 

 

Date from

 

 

 

Proficiency/

Qualification Code

 

 

Validated

 

 

 

 

 

 

Grade awarded

 

(if applicable)

 

 

Please () tick one

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

D

M

M

Y

Y

 

Y

Y

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

D

M

M

Y

Y

 

Y

Y

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

D

M

M

Y

Y

 

Y

Y

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

D

M

M

Y

Y

 

Y

Y

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

D

M

M

Y

Y

 

Y

Y

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

D

M

M

Y

Y

 

Y

Y

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

D

M

M

Y

Y

Y

Y

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HR 101_V4 Sep 2012

 

 

 

 

 

Page 2 of 6

 

Revised 25/09/2012

 

 

 

If Faxing please ensure the employee’s Name and Personnel Number are included for each page of form

Name ____________________________ Personnel No.__________________________________

8. Irish Language Proficiency

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Oral Irish

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Validated

 

 

 

 

Native

Intermediate

 

 

Fluent

 

 

Beginner/ Novice

 

None

 

Unknown / Untested

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

Written Irish

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Advanced

 

Intermediate

 

 

Basic

 

 

None

Unknown / Untested

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

9. Employee Declaration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I declare that the above information is accurate and correct on the date below. I undertake to notify my employer of any

 

 

 

 

changes to this information by completing and submitting the appropriate form.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

D

 

D

 

 

M

 

M

 

Y

 

 

Y

 

 

Y

 

 

Y

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sections 10 - 18 should be completed by Line Manager/ Human Resources

 

 

 

 

 

 

 

 

10. Appointment Details

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employed as (Grade)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cost Centre

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Care Group

 

 

 

 

 

 

 

 

Personnel Area

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employee Group

 

 

 

 

 

 

Permanent

 

 

 

 

 

 

Temporary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Officer

 

 

 

 

 

 

 

 

Non Officer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employee Sub Group

 

 

Wholetime

 

 

 

Part-time

 

 

 

Casual

 

 

Fees/ Sessions

 

 

 

 

 

Job share

 

 

 

Flexible

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Working

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fill Existing Vacancy

 

 

 

Maternity Leave Relief

 

 

 

 

 

Locum Relief

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fill New Vacancy

 

 

 

 

 

 

Sick Leave Relief

 

 

 

 

 

National Transfer

 

 

 

 

 

 

 

 

Reason for Appointment

 

 

 

Special Project

 

 

 

 

 

 

Annual Leave Relief

 

 

 

 

 

Local Transfer

 

 

 

 

 

 

 

 

 

 

 

 

 

or Action

 

 

 

 

 

 

 

 

 

 

Student Training Post

 

 

 

Career Break Cover

 

 

 

 

 

Redeployment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Community Employment Scheme

Urgent Service Needs

 

 

 

 

 

SJH Hire Pension Purposes Only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Special)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Student Summer Scheme

 

 

 

Locum On-Call Relief

 

 

 

 

 

Agency Subsumed into HSE

 

 

 

 

Name of Replaced Employee:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Replaced Employee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Personnel No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Contract – (please attach signed contract)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contract Type

 

 

 

 

 

 

Indefinite

 

Indefinite Duration

Fixed Term

 

Fixed Term

 

 

 

 

 

 

Specified

 

 

 

Specified Purpose

 

 

 

 

 

 

 

 

 

 

Duration

 

Std T&C’s

 

 

 

 

 

 

 

Std T&C’s

 

 

 

 

 

 

Purpose

 

 

 

Std T&C’s

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Consultant Contract type

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A

 

 

B

 

 

 

 

 

 

 

 

 

B*

 

 

 

 

 

 

C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Expiry Date of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Temporary Contract

 

 

 

 

D

 

 

D

 

M

 

 

M

 

Y

 

Y

 

Y

 

Y

Probation period to be served

 

 

 

 

Yes

 

No

 

 

 

 

(if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1st probationary

 

D

 

D

 

 

M

M

 

 

Y

 

 

Y

 

Y

Y

 

2nd

probationary

D

 

D

 

M

M

 

 

 

Y

Y

 

Y

 

Y

 

 

Review date

 

 

 

 

 

 

 

 

 

 

 

Review date

 

 

 

 

 

 

 

 

 

12. Allowances - Please ensure that supporting documentation is attached

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Allowance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount / Unit

 

 

 

 

 

 

 

 

 

Wage Type / Pay code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Official use only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HR 101_V4 Sep 2012

 

 

 

 

 

 

 

 

Page 3 of 6

 

 

 

 

Revised 25/09/2012

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If Faxing please ensure the employee’s Name and Personnel Number are included for each page of form

Name ____________________________ Personnel No.__________________________________

13. Work Pattern

Standard Full Time hours for this grade

 

Contract Hours (use decimals)

 

 

 

 

 

Work Schedule rule details (SAP Phase II Sites Only)

 

 

 

 

Working Week

Mon – Fri 5/5

Mon – Sun 5 / 7

Note: If an employee works a Monday to Friday roster they are classed as 5/5. These employees will never be paid Saturday allowance, Sunday premiums or Public Holiday premiums. Alternatively if an employee may work on a Saturday or Sunday they are classed as 5/7, this will allow them to be paid the relevant allowances and premiums

Work Schedule Rule*

 

 

 

 

 

 

 

 

 

 

Start week of Rotational Roster

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* (If employee is casual, enter HRPD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14. Pay Details

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work Location

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Annual Salary

 

 

 

 

 

Level (Point of Scale)

 

Grade Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Next Increment due

D

 

D

M

M

Y

Y

Y

Y

Payroll Area/Group No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pay slip distribution

 

 

Internal

 

External

 

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Payroll Frequency

 

 

Weekly

Fortnightly

 

4 weekly

Monthly

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16 Pension Details

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is this employee eligible for membership of a superannuation scheme

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please indicate the relevant main superannuation scheme and either the Spouses’ & Children’s or Widows’ & Orphans’ Scheme

 

Scheme (employees appointed

 

 

Officers

 

 

 

 

Non-Officer

 

before 1/1/2005 with no break in

 

 

 

 

 

 

 

 

 

 

 

PRSI Class A

 

PRSI Class D

 

 

 

 

service)

 

 

 

 

 

 

1956 Scheme

 

 

120

 

 

 

120

 

 

200

 

Main Scheme (1977)

 

 

160

 

 

 

140

 

 

220

 

Spouses’ & Children’s

 

 

320

 

 

 

320

 

 

420

 

Widows’ & Orphans’

 

N/A

 

 

 

300

 

 

400

 

Scheme (All New HSE employees appointed from 1 January 2005)

 

 

 

All Staff

 

Main Scheme

 

 

 

 

 

 

 

 

165

 

Spouses’ & Children’s

 

 

 

 

 

 

 

 

325

 

Superannuation Classification (to be completed in all cases)

 

 

 

 

 

 

 

New Entrant

 

 

 

 

 

 

 

 

 

 

 

Non New Entrant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HR 101_V4 Sep 2012

Page 4 of 6

Revised 25/09/2012

If Faxing please ensure the employee’s Name and Personnel Number are included for each page of form

Name ____________________________ Personnel No.__________________________________

17. Service year date (for annual leave purposes)

Note: Certain grades are entitled to incremental increases to the annual leave entitlement based on length of service in the grade. Please complete the following section so that the correct entitlement may be established.

Is the employee entitled to incremental increases to annual leave, based on length of service?

Yes

No

If No Go To Section 18

Nursing Grades only

If yes please enter the number of years, months and days of previous service.

Note: Please include all previous service in publicly funded health services in Ireland and relevant nursing experience abroad

Years

Months

Days

Other Grades

If yes please enter the number of years, months and days of relevant service at

this grade Note: Please include service if the employee was acting up continuously in the same grade immediately prior to start date

Years

Months

Days

18. Line Manager Declaration

Note: Please ensure P45 / Certificate of Tax Cut Off / PRD45 are forwarded to the appropriate payroll department

Fit Slip Attached

Yes

No

I declare that the above information is accurate and correct. I confirm that the above employee commenced employment on the date stated above and approve set up on the appropriate payroll system.

Signature

Name (Print)

Contact Tel No

E-Mail Address

Date

D

D

M

M

Y

Y

Y

Y

 

 

 

 

 

 

 

 

 

Grade

Decision Number (if applicable)

19. Delegated Officer approval

Name (Print)

Tel No

Decision No

Signature

Date

D

D

M

M

Y

Y

Y

Y

 

 

 

 

 

 

 

 

 

20. Area Employment Monitoring Group

Approval Number

Date

D D M M

Y

Y Y Y

21. To be completed by Human Resources Personnel Administration

System Updated by

Date

D

D

M

M

Y

Y

Y

Y

 

 

 

 

 

 

 

 

 

 

Comments

HR 101_V4 Sep 2012

Page 5 of 6

Revised 25/09/2012

If Faxing please ensure the employee’s Name and Personnel Number are included for each page of form

Name ____________________________ Personnel No.__________________________________

 

 

22. Payroll Section

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Location Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name (Print)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tel No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

D

 

D

 

M

M

 

Y

 

Y

 

Y

 

Y

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23. Payroll Interface (phase 1 Only)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wage Type Entered

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employment Signal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Payroll Area Change Details

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

D

 

D

 

M

M

 

Y

 

Y

 

Y

 

Y

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Main Pension Scheme

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

W&O/Spouses Scheme

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAC Completed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

D

 

D

 

M

M

 

Y

 

Y

 

Y

 

Y

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24. Circulation List

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix 1 Professional Registration additional information for multiple registrations

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Note only applies to Dentists, Doctors, Nurses, Ophthalmologists, or Pharmacists

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name on

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Issued

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Registration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

By

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of issue

 

D

D

M

M

 

 

Y

 

 

Y

 

 

Y

 

Y

 

Expiry

 

D

 

D

M

 

M

 

Y

 

 

Y

 

Y

Y

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Professional Registration / Membership Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name on

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Issued

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Registration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

By

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of issue

 

D

D

M

M

 

 

Y

 

Y

 

Y

 

Y

 

Expiry

 

D

 

D

M

 

M

 

Y

 

 

Y

 

Y

Y

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Professional Registration / Membership Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name on

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Issued

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Registration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

By

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of issue

 

D

D

M

M

 

 

Y

 

Y

 

Y

 

Y

 

Expiry

 

D

 

D

M

 

M

 

Y

 

 

Y

 

Y

Y

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Professional Registration / Membership Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HR 101_V4 Sep 2012

Page 6 of 6

Revised 25/09/2012

How to Edit Form Hr 101 V4 Online for Free

It's straightforward to fill out the V4. Our PDF editor was intended to be help you complete any PDF easily. These are the steps to follow:

Step 1: The initial step will be to click the orange "Get Form Now" button.

Step 2: After you have accessed the editing page V4, you will be able to find each of the actions available for the document within the upper menu.

These areas are contained in the PDF document you'll be completing.

stage 1 to writing 2012

Fill in the Date of Birth, Marital Status Single Married, Relevant certificates attached Yes, PPS Number, Next of Kin Emergency Contact, First Name, Relationship to you Street Address, County, Post code, Country, Contact Phone No Employment, Mobile Phone No, If currently employed by HSE, Personnel Number, and Pay group payroll area field with all the data requested by the platform.

Completing 2012 stage 2

You should be demanded some essential information so you can complete the Were you previously employed by, Name of employer, Grade, Last Day of service Personnel, D D M M, HR V Sep, Page of, and Revised section.

2012 Were you previously employed by, Name of employer, Grade, Last Day of service Personnel, D D M M, HR V Sep, Page of, and Revised blanks to fill out

Please be sure to identify the rights and obligations of the parties inside the If Faxing please ensure the, Name Personnel No, Are you in receipt of a pension, Name of Authority Employer Bank, Bank Name, Bank Sort Code, Payee Name, Professional Registration, Start Date of Payment, D M M, Bank Address, Account No, Note only applies to Medical, Name on Registration, and Date of issue space.

stage 4 to filling out 2012

End by reviewing these sections and writing the relevant data: PRSI Details, PRSI Class, Are you a Full Medical Card Holder, Yes Yes Yes Yes, No No No No, Note if you have answered yes to, Name of Qualification, Date from, D D M M Y Y Y Y, D D M M Y Y Y Y, D D M M Y Y Y Y, D D M M Y Y Y Y, D D M M Y Y Y Y, D D M M Y Y Y Y, and D D M M Y Y Y Y.

Finishing 2012 step 5

Step 3: When you have selected the Done button, your document will be accessible for upload to any electronic device or email address you identify.

Step 4: Be sure to make as many duplicates of your document as you can to keep away from potential problems.

Watch Form Hr 101 V4 Video Instruction

Form Hr 101 V4 isn’t the one you’re looking for?

Related Documents

  • Aoa 101 Form

    "... Ao form No 01, revised 03 15, copyright 2010. Apartment owners association of California inc www.aousa.com san Fernando Valley 818 988 9200 Los Angeles 323 937-8811 Long Beach 562 597 2422 Garden Grove 714 539 ..."

  • Ct Hr 12 Application Form

    "... Instructions for Completing and Submitting the State of Connecticut Application for Examination or Employment Form ct.hr 12. Please read the following carefully. This application is for the current state of Connecticut exam nation or job ..."

  • Dbpr Hr 7031

    "... Division of Hotels and Restaurants Application for Mobile Food Vehicle License with Plan Review 2017 61 002 Fa Page of State of Florida Department of Business and Professional Regulation Division of Hotels and Restaurants 2601 ..."

  • Form Dab 101

    "... Department of Health and Human Services hhs form dab 101 0809 Request for Review of Administrative Law Judge AlMedicare Decision Dismissal Appellant. Attach list of beneficiaries or claims hi cns to help identify the beneficiaries. ..."

Please rate Form Hr 101 V4

1 Votes

Related Resources

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .