Garda Vetting APPLICATION Form
NOTE TO APPLICANT
(Please state N/A if details are not applicable)
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To be completed by the Applicant
SURNAME: | PREVIOUS NAME (if any): |
FORENAME: | ALIAS: |
DATE OF BIRTH:(dd/mm/yy) | PLACE/CITY OF ORIGIN: |
HAVE YOU EVER CHANGED YOUR NAME? Yes No | |
IF YES PLEASE STATE FORMER NAME: |
Please state all addresses from year of birth to present date
House No. | Street | Town | County | Post Code | Country | Year From | Year To |
Please Continue Overleaf
No Yes Please provide details
DATE | COURT | OFFENCE | COURT OUTCOME |
DECLARATION OF APPLICANTI, the undersigned who have applied for a position as a ________________________ hereby authorise An Garda Síochána to furnish to GAA a statement that there are no convictions recorded against me in the Republic of Ireland or elsewhere, or a statement of all convictions and / or prosecutions, successful or not, pending or completed, in the State or elsewhere as the case may be. Signature of Applicant: _______________________________ Date: _________________( ) |
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CLUB: _________________ TEAM: _______________________ ROLE: _________________________ |
To be completed by GAA Offices only Authorised Signatory: _______________________________ (GAA)PLEASE PRINT ALSO ( ) Registration Number: _________ Date: ______________________
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To be completed by the Garda Central Vetting Unit
According to Garda records there are no previous convictions recorded against the above named applicant:
OR the attached convictions appear on Garda Records:
OR the attached prosecutions are pending:
NOTE: Checks were carried out by this office based on the information supplied.
The convictions supplied may apply to the subject of your enquiry.
Please verify information disclosed with the applicant.