Summary Qualifications and Relevant Experience Form
This summary qualifications and experience form has been designed to establish your eligibility requirements and quantify your most pertinent relevant experience and achievements to date. Much of the information requested here will also be required to complete the online PAC form. Where you feel that this form does not accurately capture a specific aspect of your experience to date you may provide additional details in the online PAC form as needed.
Candidate Name: ____________________________________________________ PAC Number: _________________________________
1.
Do you hold an Honours Psychology Degree or a recognised Conversion Qualification in Psychology (e.g. HDip in Psychology) from a University or third level institution in Ireland or the UK?
YES
NO
2.
Can you confirm that the above qualification confers eligibility for Graduate Membership of the Psychological Society of Ireland or the Graduate Basis for Chartered (GBC) membership of the British Psychological Society?
YES
NO
Important Note: If you have any doubts concerning your eligibility for Graduate Membership of The Psychological Society of Ireland you should obtain clarification prior to submitting your application. If you obtained your primary honours degree in psychology or your conversion qualification in psychology outside the Republic of Ireland you must provide evidence of eligibility for Graduate Membership of the Psychological Society of
Ireland or the Graduate Basis for Chartered (GBC) membership of the British Psychological Society otherwise your application will not be considered.
3.
Indicate either your Psychology Degree or Conversion Qualification grade here only.
(Please indicate your relevant qualification grade by entering X in one column below only)
1 st
2.2
2.1
3 rd
Primary Psychology Degree
(e.g. BA (Hons) or BSc (Hons) in
Psychology)
Conversion Qualification
(e.g. HDip in Psychology)
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Summary Qualifications and Relevant Experience Form
4.
Relevant Work Experience (please add additional rows as needed and complete all columns)
Note: You must provide all required information below, otherwise your experience will be disregarded for calculation purposes.
Job title*
Indicate if Paid/Unpaid
Assistant Psychologist supervised by a Clinical
Psychologist
(Unpaid)
Employer Name & Address
HSE West
Merlin Park Hospital
Co. Galway
Name and Full Professional
Title of your Primary
Supervisor
Dr Sheila Wilson
Senior Clinical Psychologist
Period of
Employment
December ‘13 to May ‘14
Duration of Post
(in months)
6
Hours Per
Week
15
Official use only
* Note: For coding purposes use the following job titles in Section 4
A.
Psychologist with Post-Graduate Professional Training (e.g. Educational/ Counselling Psychologist)
B.
Assistant Psychologist (or equivalent title) supervised by a Clinical Psychologist
C.
Research Assistant / Research Associate / Research Fellow supervised by a Clinical Psychologist
D.
Professionally qualified Social Worker, Occupational Therapist, Speech & language Therapist, Physiotherapist
E.
Research Assistant / Research Associate / Research Fellow not supervised by Clinical Psychologist
F.
Graduate Psychologist under supervision of a Psychologist (not a Clinical Psychologist)
G.
ABA Tutor / Behaviour Support Specialist, Senior/Specialist Nurse
H.
Graduate Psychologist under supervision of a related professional discipline (e.g. Psychiatrist)
I.
Psychology Tutor/Lecturer
J.
Senior or Specialist Nurse
K.
Registered Nurse, Counsellor, Addictions Counsellor
L.
Play therapist, Care Worker, Residential Worker, Support Worker,
M.
Other Health or Social Care roles not otherwise specified
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Summary Qualifications and Relevant Experience Form
5.
Additional academic achievements ( note: not all applicants will have additional academic achievements).
Peer-reviewed
References here (e.g. O’Dwyer, M. (2015). Burnout in clinical psychology training. Clinical Psychology Forum , 14 (8), 4-15.)
Publications
(APA Format Please)
Other Publications
(e.g. HSE Report)
References here
Conference Presentations References here
Prizes, Merits,
Scholarships or
Distinctions
Description here for each
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