Special Needs Assistant (SNA) Appointment Form 2020/2021

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Special Needs Assistant (SNA) Appointment Form –2020/2021Incomplete forms will be returned to the School.THIS FORM SHOULD BE ACCOMPANIED BY A COPY OF A LETTER OF SANCTION FROM THESPECIAL EDUCATIONAL NEEDS ORGANISER (SENO)School DetailsSNA DetailsRoll NumberSchool NamePPS NumberE-mailPayroll No.Phone No.First NameAppointment DetailsSurnameHas the school confirmed that this new appointee is withintheir current SNA Allocation?AddressYES NO Full TimePart TimeIf Part time, give details of post, e.g., 0.83, 0.5Date of Birth/ /Gender Tick if you would like to receive your correspondencethrough Irish.Phone No.E-mailCivil Status (See Appendix A)Start Date of AppointmentEnd Date of AppointmentIf end-date is unknown, please inform NTS Payroll Section at leasttwo weeks prior to end date to avoid overpayment.Origin of PostE.g. a New post, Replacing Retirement, Resignation Job-share, Careerbreak replacement, Secondment, Death, Other (state reason)If it is not a new post (New/Additional NCSE Allocation), pleasecomplete this section.Name of PredecessorDate of LeavingBANK DETAILS FOR LODGEMENT OF SALARY (BLOCK CAPITALS):Bank DetailsBank NameBank AddressName on AccountA/C IBANA/C BICNB: Please ensure your Bank Account is within the Republic of Ireland and is SEPA compliantOnce fully completed, this document should be returned to the following address:Please include the Roll No. on the outside of the envelopePayment on the first issue of the 2020/2021Non-Teaching Staff (NTS) Payroll Division,Department of Education and Skills,school year can only be guaranteed if this 1Cornamaddy,form is received by NTS Payroll Division byAthlone,Friday 10th of July 2020Co. Westmeath

Garda VettingStatutory vetting obligations under the National Vetting Bureau (Children and VulnerablePersons) Acts 2012 to 2016 and Circular 31/2016 effective from the 29 th of April 2016.This section must be completed.Note: SNAs being redeployed are subject to the requirements of both the National Vetting Bureau (Children and Vulnerable Persons) Act 2012 to 2016and Circular 0031/2016. Tick to indicate that the school authority has complied with its statutory vetting obligations under the National VettingBureau (Children and Vulnerable Persons) Acts 2012 to 2016 and with the requirements of Circular 0031/2016 in respectof this proposed appointment.If this requirement has not been met the proposed appointee is not eligible to be appointed. The appointment formshouldnot be submitted. The school authority should also be aware that it is a criminal offence not to comply with a vettingobligation under the National Vetting Bureau (Children and Vulnerable Persons) Acts 2012 to 2016.Medical Fitness Tick to indicate that you have received confirmation from the Occupational Health Service in respect of the proposedappointee’s fitness to undertake duties as an SNA in accordance with the Occupational Health Service Standard OperatingProcedures Manual.Standard Operating Procedures Manual is available on www.education.ie. Circular 0054/2015 refers.If not, the appointment form for this SNA should not be completed until confirmation is received.Previous Employment DetailsKeeping your tax information up to date with Revenue is your responsibility. If you need to make contact withthem regarding this employment they may ask for our Employer Reg. No., which is 9599516K.Qualifications Tick to indicate that the proposed appointee has the minimum educational qualifications for the appointment.If this requirement has not been met the proposed appointee is not eligible to be appointed.2

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 DeclarationAny queries regarding this Declaration should be directed to Pension Unit at pensions@education.gov.ieWarning: If we do not receive this form completed fully & accurately, there will be a delay commencing you into a pension scheme and thereforeyou 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(a) takes up employment in a public service body, and(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 tothe relevant authority.1. CAREER HISTORY (Required ONLY for Public Sector employments in Ireland which may include employment outside ofthe teaching/education sector E.g. HSE, ETB, Civil Service etc. (Your NTS Service is not required)You must include a verified copy of the service history for any service outlined in the table belowEmployerDates of Employment (From – To)2. I hereby declare that I am I am notfrom any other public service body.Pensionable (Y/N)tick as appropriate) currently in receipt of any remuneration (pay)REMUNERATION/PAY (Please complete if ticked “I am” above)DescriptionAnnual gross payPaying authority% of Full time position3. I hereby declare that:a) I have receivedI have not receivedor I am in receiptof retirement benefits (tick as appropriate) ORb) I haveI do not have(tick as appropriate) an entitlement to any of the pension benefits specified above.PENSION BENEFIT CURRENTLY IN PAYMENT (Please complete if ticked “I have/I am” above)Description (Retirement, Ill Health, EarlyRetirement, )Paying authority(a) PENSION BENEFIT FUTURE ENTITLEMENTS (Please complete if ticked “I have” above)DescriptionPaying authoritySigned:Name (Block Capitals):Date of Birth:PPS Number:Payroll Number:Date:For Office Use only:Single Scheme Member Y/N:Sent to Pension Unit:Recorded by:3

Guidance Note for completing the Declaration under the Single Scheme ActIf you are an SNA taking up a post in the Public Sector (E.g. HSE, Civil Service, ETB etc.) for the FIRST time, youwill not already have an entitlement to a pension therefore you should complete this declaration as follows:1. Career HistoryNot Applicable2. Remuneration/PayThis should be ticked as “I am not” employed in any other Public SectorPost and not in receipt of salary prior to this appointment.3. Pension BenefitYou should tick “I have not received” at (a) and “I do not have” at (b) No otherinformation is required in the boxes below.The form should be signed, dated and PPSN includedIf you are an SNA taking up a post in the Public Sector having worked in an SNA post previously and/or in thewider Public Sector, you may have an entitlement to a pension as a result of that employment therefore you shouldcomplete this declaration as follows:1. Career HistoryYou should include service completed in Ireland either/bothin SNA posts and/or the wider Public Sector.2. Remuneration/PayThis should only be ticked as “I am” if you are currentlyemployed in another Public Sector Post otherwise tick “I am not”3. Pension BenefitYou should tick “I received” at (a) if you have previously paid apension contribution in any SNA post/Public Sector Body andclaimed a pension benefit on foot of these contributions.You should tick “I have not received” at (a) if you have previously paid apension contribution in any SNA post/Public Sector Body to the currentdate and may be due a pension at a date in the future on foot of thesecontributions.You should tick “I am in receipt” at (a) if you are currently receiving a pensionbenefit having paid a pension contribution from any SNA post/PublicSector Body.You should tick “I have” at (b) if you have ever paid a pensionpension contribution in any SNA post/Public Sector BodyBody and have an entitlement to claim a benefit in the future.You should tick “I do not have” at (b) if you have ever paid a pensioncontribution in any SNA post/Public Sector Body but do not have anentitlement to claim a benefit in the future (e.g. obtained a refund ofcontributions).The form should be signed, dated and PPSN included4

Form of Authorisation – Illness Benefit PaymentsThe mandate below should be completed by Special Needs Assistants liable for PRSI Class A.Payment of salary during periods of absence is dependent on compliance with PRSI regulations.FORM OF AUTHORISATION - ILLNESS BENEFIT PAYMENTSI have read and understand the conditions and procedures involved in the operation of illness benefit pay schemesapplicable to SNA's.I am aware that depending on my PRSI contribution record I may be entitled to payment from the Department ofEmployment Affairs and Social Protection in respect of absences under these schemes.I acknowledge that payment from the Department of Education and Skills during absence on illness leave will besubject to the following conditions:(a) that I make the necessary claims for illness benefit to the Department of Employment Affairs and SocialProtection within the required time limits and will, to the best of my ability, comply with whateverrequirements are laid down by that Department as a condition of claiming such benefit;(b) that I agree to any amendments to the payment of the Illness Benefit scheme that may be introduced bythe Department of Education and Skills in the future.I also acknowledge that any payments due to me from the Department of Employment Affairs and SocialProtection in respect of such absences under the current arrangements for payment may be recovered bydeduction from my salary in the event that I fail to comply with the foregoing conditions.Accordingly, I accept that in order to ensure compliance with the above undertaking and the illness leaveregulations, the Department of Education and Skills may be required to make direct contact with the Departmentof Employment Affairs and Social Protection to establish what payments were made to me, when they were madeand the amount and duration of such payments.I hereby authorise the Department of Education and Skills to make such enquiries. I understand that anyinformation obtained from the Department of Employment Affairs and Social Protection will be used only for theforegoing purposes and will not be disclosed to any unauthorised person.Signed (SNA)PPS No.DateSchool Roll No5

SNA Checklist and DeclarationIn the case of each of the following I certify that:1. I the undersigned declare that the information recorded in this document istrue accurate and complete. I understand that I am responsible for theaccuracy of the information and that if I wilfully supress any information Irisk the loss/termination of appointment.2. I have read, signed and received my contract of employment and agree toabide by the terms (Circ 0012/2005 and 0015/2005 refer) and I understandthat this post may be terminated by means of redundancy and I have read andfamiliarised myself with the terms of Circ 0058/2006 which governs the SNARedundancy scheme.3. I have completed the self-declaration where appropriate in accordance withparagraph 4 of circular 07/2013 titled The Single Public Service PensionScheme for Teachers and Special Needs Assistants employed in Primary andSecondary Community/Comprehensive Schools.4. I confirm that, in accordance with the requirements of Garda VettingCircular 0031/2016, I have provided the school authority with a childprotection related statutory declaration which was made in the current or theprevious calendar year.5. I confirm to the school authority that since the date on which I signed thatstatutory declaration, to the best of my knowledge and belief there is nothing,from a child protection perspective, in relation to my conduct, character orpersonal background of any nature that would adversely affect the position oftrust in relation to children or vulnerable persons in which I would be placedby virtue of my appointment to an SNA post in this school.6. I acknowledge and understand that any false or misleading confirmation asto my conduct, character or personal background or any failure of mine toinform the school authority of relevant changes that may affect my suitability,from a child protection perspective, will constitute a breach of my contract ofemployment and may be grounds for summary dismissal by the schoolauthority.7. I am aware that I am not now, or in the future, required to disclose to aschool authority details of any convictions regarded as spent under theCriminal Justice (Spent Convictions and Certain Disclosures) Act 2016 butthat, in accordance with Section 10 of that Act, this does not however applyin the case of any conviction in respect of offences specified in Part 1 or 2 ofSchedule 1 of that Act or those specified in Schedule 3 of the NationalVetting Bureau (Children and Vulnerable Persons) Acts 2012 to 2016.8. I also undertake to inform the above school authority of any changes to theabove stated position that may affect my suitability, from a child protectionperspective, for continued employment with the school authority or for anysubsequent employment with the school authority.9. I will refund to the Minister for Education and Skills any monies tome which are not properly payable. I agree to comply with theDepartment's Overpayment Policy as outlined in Circular 84/2015 inthis regard.10. I understand the conditions and procedures involved in the operation ofmaternity/adoptive pay schemes.11. I have read the SNA Payroll Information Note.12. I have signed the mandate form, Form of Authorisation (illness benefitpayments).13. I understand that upon receipt of all relevant documentation in theDepartment it may take 8 weeks before payment is made to me. This is due tocompletion of the payroll process and if this document is returned incompletethat I will not be paid salary until after a fully completed form is received andprocessed by the Department.14. I declare that I will seek approval from my employer before engaging inany external work and that any external work engaged in by me must not besuch as to interfere with the fulfilling of my duties and responsibilities to theschool.15. Additional Superannuation Contribution (ASC) arises from the PublicService Stability Agreement (PSSA, 2018-2020) and the provisions of Part 4of the Public Service Pay and Pensions Act 2017.Principal/Chairperson’s Checklist and DeclarationIn the case of each of the following I certify that:1. All relevant sections of this document have beencompleted and the details therein are true and accurate.2. A written contract of employment has been signed by bothparties, this contract is held in this school and a copy hasbeen given to the SNA (Circ 12/05 and 15/05 refer).3. I accept that it is the responsibility of the school authorityto ensure that this form is correctly completed in order forsalary to be paid to the appointee.4. In the case of new appointees to the school, I certify that, Ihave checked employment references with at least 2 of themost recent employers and also verified with them the mostrecent employment history.5. I have received confirmation of fitness to undertake dutiesas an SNA in respect of the proposed appointee from theOccupational Health Service.6. I verify that the requirements of the National VettingBureau (Children and Vulnerable Persons) Acts 2012 to2016, and Garda Vetting Circular 0031/2016 have been metin respect of this proposed appointee.Principal/Chairperson SignatureDate:Further information regarding ASC can be found on the Department'swebsite at www.education.ieSNA SignaturePrincipal/Chairperson’s SignatureDateNote: the proposed appointee and the principal must sign this section in eachother’s presence6

DATA PROTECTION PRIVACY STATEMENTThe 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 withyour 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 Employment Affairsand Social Protection., the Department of Public Expenditure and Reform as required by law; and any other bodieswhom you have instructed to arrange for voluntary deductions to be made from your wages. The privacy noticeoutlining further information in relation to this form can be found at www.education.ieFull details of the Department's data protection policy setting out how we will use your personal data or that of yourchild’s data as well as information regarding your rights as a data subject are available Protection/. Details of this policy and privacy notice are alsoavailable in hard copy from the address below upon request.Once fully completed, this document should be returned to the following address:Pleaseincludethe Roll No.on the outsideof the envelopeDATAPROTECTIONPRIVACYSTATEMENTThe main purpose for which the Department requires the personal data provided by you is the payment of wages.It is also necessarythe paymentpension at retirement. The personal data provided may be exchanged withNon-TeachingStafffor(NTS)Payroll ofDivision,your school in respect of your appointment as required by your contract; the Teaching Council, where appropriate,Departmentof Education and Skills,in respect of the status of your registration, the Revenue Commissioners, the Department of Employment AffairsCornamaddy,and Social Protection., the Department of Public Expenditure and Reform as required by law; and any other bodiesAthlone,whom you have instructed to arrange for voluntary deductions to be made from your wages. The privacy noticeCo.Westmeathoutliningfurther information in relation to this form can be found at www.education.ieN37FullX659details of the Department's data protection policy setting out how we will use your personal data or that of yourchild’s data as well as information regarding your rights as a data subject are available Protection/. Details of this policy and privacy notice are alsoContact Details0906 48 4136available in hard copy from the address below upon request.ntspayroll@education.gov.ieEmployer Reg No9599516KPayment on the first issue of the 2020/2021school year can only be guaranteed if thisform is received by NTS Payroll Division byFriday 10th of July 2020Payment on the first issue of the 2020/2021school year can only be guaranteed if thisform is received by NTS Payroll Division byFriday 10th of July 20207

APPENDIX ACivil Status11 options that describe a person’s relationship in law with another:1.2.3.4.5.6.7.8.9.10.11.SingleMarriedCivil PartnerDivorcedCo-habitantJudicially SeparatedSeparatedFormer Civil PartnerWidowedSurviving Civil PartnerUnknownIf Civil Status is not known, “Unknown” is selected until status is determined.DEFINITION OF CIVIL STATUS (AS RECOGNISED UNDER IRISH NATIONAL LAW ):OptionDefinitionSingleAn individual who has never been married or in a civil partnership.MarriedAn individual or two persons of any gender who have registered a marriagewith the State.Civil PartnerAn individual who is either of two persons of the same gender who are partiesto a civil partnership registration recognised by the State that has not beendissolved or the subject of a decree of nullity.DivorcedAn individual who was previously married and a decree of divorce has beengranted by the relevant court under Family Law (Divorce) Act 1996 or is sorecognised under Irish law.Co-habitantA 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 andwho are not related to each other within the prohibited degrees of relationshipor married to each other or civil partners of each other.Judicially SeparatedAn individual who has been granted a decree of judicial separation under

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. 5. 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,

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