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Number AF: Pay 16
Primary Teachers Appointment Form 2024/2025
Incomplete forms will be returned to the School.
Teacher Details
School Details
Roll Number
School Name
e-mail
Phone No.
Employment Details
Contract Type
PPS Number
Payroll No.
First Name
Surname
Hours
Gender
Correspondence Address
(e.g. Permanent, CID, Fixed term wholetime, fixed term part -time)
Type of Post
(e.g. Principal, Mainstream, SET, Specialist Subject)
Start date of Appointment:
All correspondence to personnel paid on the Department’s payroll must issue to this
address (not school address)
Date of birth
Civil Status (see appendix A)
Phone No.
e-mail
End Date of Fixed Term Appointment*:
(*in case of Fixed Term appointment – please complete end-date if known)
Origin of the Post:
Bank Details (not to be completed unless the account details have changed). NB: Please ensure your Bank Account
is SEPA compliant. Due to the withdrawal of Ulster Bank and KBC from the Irish market, please ensure your bank
account details have been updated if you have an account with these banks.
Bank Name
Bank Address
Name on Account
IBAN
BIC
Once fully completed this form can be signed, scanned and submitted in pdf format using the contact form available online at
https://dessurveys.education.gov.ie/surveys/Payroll-Query-Form
To ensure this appointment is set up for payment in September 2024 this form must be received
completed by Friday 12th July 2024
Name of Teacher(s) being replaced:
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Details of Teaching Council Registration
Tick to certify that you are currently registered with the Teaching Council for the purpose of Primary teaching, in
accordance with circulars 31/2011, & 44/2019.
Teaching Council Registration No.:
Note: It is the teacher’s responsibility to ensure Teaching Council registration is in order, renewed in time and kept up-to date. A teacher
cannot be paid for any period where they are not registered for Primary teaching, or where they have allowed their registration to lapse.
It is the school’s responsibility to verify that the proposed appointee is currently registered with the Teaching Council.
Garda Vetting
Statutory vetting obligations under the National Vetting Bureau (Children and Vulnerable Persons) Acts 2012 to 2016 and
Circular 31/2016 effective from 29 April 2016.
This section must be completed.
Note: Teachers being redeployed are subject to the requirements of both the National Vetting Bureau (Children and Vulnerable Persons) Act 2012 to 2016 and circular 31/2016
Tick to indicate that the school authority has complied with its statutory vetting obligations under the National Vetting
Bureau (Children and Vulnerable Persons) Acts 2012 to 2016 and with the requirements of Circular 0031/2016 in respect
of this proposed appointment.
If this requirement has not been met the proposed appointee is not eligible to be appointed. The appointment form
should not be submitted. The school authority should also be aware that it is a criminal offence not to comply with a
vetting obligation under the National Vetting Bureau (Children and Vulnerable Persons) Acts 2012 to 2016.
Medical Fitness to Teach
Tick to indicate that you have received the ‘Medical Fitness for Employment Assessment Report’ from the proposed
appointee confirming medical fitness to teach, in accordance with the Occupational Health Service Employers Procedures
Manual.
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To be appointed a teacher must be registered with the Teaching Council, Garda vetted and be medically fit to teach.
If these are not fully complied with do not submit this form.
Form of Authorisation – Illness/ Injury Benefit Payments
(NOT to be completed if being reappointed in a Permanent/CID/Temporary capacity the same school as last year)
Further Information available at https://www.gov.ie/en/collection/efad5-payroll-services/
The mandate below should be completed by teachers who are liable for PRSI Class A.
Payment of salary during periods of absence is dependent on compliance with PRSI regulations.
I have read and understand the conditions and procedures involved in the operation of illness benefit pay schemes applicable to Primary teachers.
I am aware that depending on my PRSI contribution record I may be entitled to payment from the Department of Social Protection
in respect of absences under these schemes. I acknowledge that payment from the Department of Education during absence on illness leave
will be subject to the following conditions:
(a)
that I make the necessary claims for illness / injury benefit to the Department of Social Protection within the required time limits and
will, to the best of my ability, comply with whatever requirements are laid down by that Department of Social Protection as a
condition of claiming benefit.
(b)
that I agree to any amendments to the payment of the Illness/ Injury Benefit scheme that may be introduced by the Department
of Education in the future.
I also acknowledge that any payments due to me from the Department of Social Protection in respect of such absences under the current
arrangements for payment will be recovered by deduction from my salary.
PPS No.
Signed (Teacher)
Date
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teacher.
3. I accept that it is the responsibility of the school authority to
ensure that this form is correctly completed in order for salary and
allowances, where applicable, to be paid to the appointee.
4. I have verified that the appointee is currently registered with the
Teaching Council.
5. In respect of new one year fixed-term contracts being offered for
the 2024/25 school year, or a new CID contract, I certify that the
terms of Circular 0023/2015 have been complied with.
6. I have checked employment references with at least 2 of the most
recent employers and also verified with them the most recent
employment history.
7. I have received confirmation of fitness to teach in respect of the
proposed appointee from the Occupational Health Service.
8. I verify that the proposed appointee has qualifications suited to the
purpose of the post and meets the criteria for which s/he is
proposed (Refer to Circular 31/2011, & 44/2019)
9. I verify that the requirements of the National Vetting Bureau
(Children and Vulnerable Persons) Acts 2012 to 2016 and Garda
Vetting Circular 0031/2016 have been met in respect of this
proposed appointee.
10. I confirm that this appointment is in accordance with the
terms of Circular 0011/2024 Staffing Arrangements in Primary
schools for the 2024/2025 school year.
11. The teaching vacancy became known to me on:
12. Is this Teacher taken from a Redeployment Panel: Yes? No
13. If yes, please state Redeployment Panel
14. This vacancy was notified to the relevant redeployment panel
operator (e.g. Diocesan Secretary) or the Department where no
panel applies on:
15. If the vacancy was not filled by a permanent or CID holding
teacher from a redeployment panel, please state the reason why.
1. All relevant sections of this document have been completed and
the details therein are true and accurate.
1. I the undersigned declare that the information recorded in this
document is true, accurate and complete. I understand that I am
responsible for the accuracy of the information and that if I
wilfully supress any information I risk the loss of appointment.
2. I am currently registered with the Teaching Council and I will
continue to renew my registration with the Teaching Council for
the duration of my appointment. I have agreed to have my
qualification details made available to the Dept.
3. I understand that Section 30 of the Teaching Council Act 2001
makes it a requirement for me to maintain my registration with the
Teaching Council in order to be paid a salary by the Dept.
Education in accordance with Circular 0044/2019.
4. I have read, signed and received my contract of employment and
agree to abide by the terms of said contract.
5. I have completed the self-declaration where appropriate in
accordance with paragraph 4 of circular 07/2013 titled The Single
Public Service Pension Scheme for Teachers and Special Needs
Assistants employed in Primary and Secondary,
Community/Comprehensive Schools.
6. I confirm that, in accordance with the requirements of Garda
Vetting Circular 0031/2016, I have provided the school authority
with a child protection related statutory declaration which was
made in the current or the previous calendar year.
7. I confirm to the school authority that since the date on which I
signed that statutory declaration, to the best of my knowledge and
belief there is nothing, from a child protection perspective, in
relation to my conduct, character or personal background of any
nature that would adversely affect the position of trust in relation
to children or vulnerable persons in which I would be placed by
virtue of my appointment to a teaching post in this school.
8. I acknowledge and understand that any false or misleading
confirmation as to my conduct, character or personal background
or any failure of mine to inform the school authority of relevant
changes that may affect my suitability, from a child protection
perspective, will constitute a breach of my contract of employment
and may be grounds for summary dismissal by the school
authority.
9. I am aware that I am not now, or in the future, required to disclose
to a school authority details of any convictions regarded as spent
under the Criminal Justice (Spent Convictions and Certain
Disclosures) Act 2016 but that, in accordance with Section 10 of
that Act, this does not however apply in the case of any conviction
in respect of offences specified in Part 1 or 2 of Schedule 1 of that
Act or those specified in Schedule 3 of the National Vetting
Bureau (Children and Vulnerable Persons) Acts 2012 to 2016.
10. I also undertake to inform the above school authority of any
changes to the above stated position that may affect my suitability,
from a child protection perspective, for continued employment
with the school authority or for any subsequent employment with
the school authority.
11. I will refund to the Minister for Education any monies to me
which are not properly payable. I agree to comply with the
Department's Overpayment Policy as outlined in Circular 84/2015
in this regard.
12. I understand the conditions and procedures involved in the
operation of maternity/adoptive pay schemes. Circular 54/2019
13. I have read the Information Note for Primary Teachers.
14. I have signed the mandate form, Form of Authorisation (illness
benefit payments)
15. I understand that upon receipt of all relevant documentation in the
Department it may take 8 weeks before payment is made to me.
This is due to completion of the payroll process and if this
document is returned incomplete that I will not be paid salary until
after a fully completed form is received and processed by the
Department.
16. I declare that I will seek approval from my employer before
engaging in any external work and that any external work engaged
in by me must not be such as to interfere with the fulfilling of my
duties and responsibilities to the school.
Signed: Principal /School Manager / Chairperson
Date
In the Case of the appointment of a Principal Teacher please ensure that
the form is signed by the teacher and countersigned by the Chairperson
of the Board of Management.
Teacher’s Checklist and Declaration
In the case of each of the following I certify that:
Principal/Chairperson’s Checklist and Declaration.
In the case of each of the following I certify that:
2. A written contract of employment has been signed by both parties,
this contract is held in this school and a copy has been given to the
Signed: Teacher
Date
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Data Protection Privacy Statement
The main purpose for which the Department requires the personal data provided by you is the payment of wages. It is
also necessary for the payment of pension at retirement. The personal data provided may be exchanged with your
school in respect of your appointment as required by your contract; the Teaching Council, where appropriate, in respect of
the status of your registration, the Revenue Commissioners, the Department of Social Protection, the Department of Public
Expenditure and Reform as required by law; and any other bodies whom you have instructed to arrange for voluntary
deductions to be made from your wages.
In addition to collecting personal data for the purposes of payroll processing some personal data provided by newly
appointed Principals and Deputy Principals may be exchanged with the Department funded Teacher Education Support
Services for the purposes of planning and providing Continuing Professional Development supports to Principals and
Deputy Principals.
The privacy notice outlining further information in relation to this form can be found at:
https://www.gov.ie/en/collection/general-data-protection-regulation-gdpr-privacy-notices/
Full details of the Department's data protection policy setting out how we will use your personal data or that of your child’s
data as well as information regarding your rights as a data subject are available at:
https://www.gov.ie/en/organisation-information/data-protection/
Details of this policy and privacy notice are also available in hard copy from the address below upon request.
Notes on Completion of this Form.
1. Once fully completed this form can be signed, scanned and submitted in pdf format using the contact form
available online at https://dessurveys.education.gov.ie/surveys/Payroll-Query-Form .
2. Forms for individual teacher appointments should be submitted separately.and duplicate copies of the same appointment
form should not be submitted both electronically and by post.
3. Declaration Under the Single Scheme Act only applies if the teacher has previous non primary teaching public service
or pension entitlements (e.g. HSE, ETB, Civil Service etc.)
4. Please complete the form available online below if your bank details have changed.
https://www.gov.ie/en/form/48283-change-of-bank-details/
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11 options that describe a person’s relationship in law with another:
1. Single
2. Married
3. Civil Partner
4. Divorced
5.
Co-habitant
6. Judicially Separated
7. Separated
8. Former Civil Partner
9. Widowed
10. Surviving Civil Partner
11. Unknown
If Civil Status is not known “Unknown” is selected until status is determined.
Civil Status
Appendix A
Definition of Civil Status (As recognised under Irish national law):
Option
Definition
Single
An individual who has never been married or in a civil partnership.
Married
An individual or two persons of any gender who have registered a
marriage with the State.
Civil Partner
An individual who is either of two persons of the same gender who are
parties to a civil partnership registration recognised by the State that
has not been dissolved or the subject of a decree of nullity.
Divorced
An individual who was previously married and a decree of divorce has
been granted by the relevant court under Family Law (Divorce) Act
1996 or is so recognised under Irish law.
Co-habitant
A cohabitant is one of 2 adults (whether of the same or the opposite
gender) who live together as a couple in an intimate and committed
relationship and who are not related to each other within the
prohibited degrees of relationship or married to each other or civil
partners of each other.
Judicially Separated
An individual who has been granted a decree of judicial separation
under the Family Law Act 1995 or is so recognised under Irish Law.
Separated
An individual who has separated by agreement without having
obtained a decree of judicial separation under the Family Law Act
1995.
Former Civil Partner
An individual that was in a registered civil partnership that has been
dissolved (other than through the registration of the marriage of a
couple previously in a registered civil partnership).
Widowed
An individual that was married and has been predeceased by their
spouse and who has not subsequently remarried.
Surviving Civil Partner
An individual that was civil partnered and has been predeceased by
their spouse and who has not subsequently entered another civil
partnership or married.
Unknown
This field is used when the current civil status of a member is not
known and cannot be readily established. This field is only used until
the civil status is determined.
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The Declaration form should be signed, dated and PPSN included
Have you current public sector employment in Ireland ? Yes No
(Other than as a primary Teacher)
Have you previous public sector service in Ireland? Yes No
(Other than as a primary Teacher)
Are you currently in receipt of a public service pension Yes No
(including a primary teacher's pension)
Have you an entitlement to any future public service pension benefit? Yes No
(Other than a future pension from Primary Teaching and/or old age pension)
If "Yes" to any of the above please read the guidance note below and complete and sign the Declaration under the
Single Scheme Act.
If "No" to all of the above you do not need to complete the Declaration.
If you have had a previous public sector employment in Ireland please complete Section 1
“Career History” on the Single Scheme Act Declaration form attached. (Public Sector Service might include
the HSE, ETB, Civil Service etc. Details of previous Primary Teaching employment is not required).
If you are currently in receipt of any remuneration (pay) from any other Public Service body please
complete Section 2 “Remuneration /Pay” on the Declaration form attached.
If you are in receipt of, or have an entitlement to a Pension Benefit from the Department of Education or any other
Public Service Body please Complete Section 3 “Pension Benefit” on the Declaration Form attached.
Guidance Note for Completing the Declaration under the Single Scheme Act
Declaration under the Single Scheme Act
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Signed:
Name (Block Capitals):
Date of Birth
PPS Number:
Payroll Number:
Date:
Declaration under the Single Scheme Act
(Must be completed by persons taking up an appointment in the public service)
Please use attached Guidance Note to assist in the completion of this Declaration
Any queries regarding this Declaration should be directed to Pension Unit at [email protected]
Warning: If we do not receive this form completed in full & accurately there will be a delay commencing you into a pension scheme and
therefore you may have to pay pension deduction arrears
Section 51 (Duty to make declarations, etc.) of the Public Service Pensions (Single Scheme and Other Provisions) Act 2012 requires that: Any person
who
takes up employment in a public service body, and(a)
(b) either—
(i) has an entitlement to any preserved pension or any preserved lump sum or any other retirement benefit, or
(ii) has received or is in receipt of retirement benefits,
under a pre-existing public service pension scheme of which he or she was or is a member, shall provide a declaration to that effect to
the relevant authority.
1. CAREER HISTORY (Required ONLY for Public Sector employments in Ireland which may include employment outside of the
teaching/education sector E.g. HSE, ETB, Civil Service etc. (Your Primary Teaching Service is not required)
You must include a verified copy of the service history for any service outlined in the table below
Employer Dates of Employment Pensionable Y/N
2. I hereby declare that I am currently in receipt of remuneration (pay) from another public service body.
REMUNERATION/PAY (Please complete if ticked “I am” above)
Description
Annual gross pay
Paying authority
% of Full time position
3. I hereby declare that:
(a) I am currently in receipt of pension benefits OR (b) I have an entitlement to future pension benefits specified below.
(a) PENSION BENEFIT CURRENTLY IN PAYMENT (Please complete if ticked “I am” above)
Description (Retirement, Ill Health,
Early Retirement, )
Paying authority
(b) PENSION BENEFIT FUTURE ENTITLEMENTS (Please complete if ticked “I have” above).
Description
Paying authority
For Office Use only:
Single Scheme Member Y/N:
Sent to Pension Unit:
Recorded by:
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