Transcription of Police Certificate Application Form
1 11. If you have ever been known by any other names including by deed poll, previous marriage or use of your name in Irish, please provide them. Name (as it appears on your birth Certificate ) 6. Surname Police Certificate Application form This Application form must be completed using BLOCK CAPITALS Notes: Police Certificates are issued solely for information for the following purposes:- Foreign Consular Authorities Foreign Visas Establishing a Business in another EU State A Police Certificate CANNOT be construed as Garda vetting, a security clearance or a character reference. Garda vetting is not conducted for persons on an individual basis.
2 It is only conducted in respect of personnel working in full-time, part-time, voluntary or in a student placement capacity in a position in an organisation, through which they have unsupervised access to children and/or vulnerable adults. Garda vetting Application forms can only be obtained from an organisation registered with the Garda Central Vetting Unit to vet its prospective employees. A Police Certificate is issued by the Superintendent in the District where the relevant applicant resides, or formerly resided, in the Republic of Ireland. The Certificate is issued free of charge. You should also include with your Application : A copy of your passport, driving license or similar for identification purposes A stamped, self addressed envelope Your Application will take approximately three weeks to process.
3 1. Country Application relates to 2. Purpose of Visa/immigration Application Establishing a business in another EU state Application 3. First name(s) 4. Surname 5. First name(s) 7. Maiden name (if applicable) 8. Date of birth 9. Gender Male Female 10. Place of If born in the Republic of Ireland, please state County. If born abroad, please state Country. birth First name(s) Surname If you need more space for additional names please use another sheet and attach it to this Application . 12. Mobile tel. number 13. Landline tel. number 14. Email address Please continue overleaf Part 2: Personal Details Part 1: Application Details D D DD M M DD Y Y Y Y DD Part 3.
4 Contact Details Other purpose as required by a foreign consular authority (Please specify) M M DD M M DD M M DD M M DD M M DD M M DD Y Y Y Y DD Y Y Y Y DD Y Y Y Y DD Y Y Y Y DD Y Y Y Y DD Y Y Y Y DD M M DD Y Y Y Y DD 15. Your current address and when you started living there From Address line 1 Address line 2 Town/City County Postcode 16. All other addresses which you have lived at in Ireland and when you lived there Previous address 1 From To Address line 1 Address line 2 Town/City County Postcode Previous address 2 From To Address line 1 Address line 2 Town/City County Postcode Previous address 3 From To Address line 1 Address line 2 Town/City County Postcode If you need more space for additional addresses please use another sheet and attach it to this Application .
5 17. I hereby declare that: I have listed all the names by which I have ever been known. I authorise An Garda S och na to make any enquiries it deems necessary in order to process this Application and verify the information contained herein. The information I have given in this Application is correct. Applicant s signature Date Part 4: Address Details Part 5: Applicant Declaration D D DD M M DD Y Y Y Y DD
