Part-Time Education Option Application Form (PTEO1)

Published date19 November 2020
IssuerDepartment of Social Protection
Your own details
1. Your PPS Number:
3. Your Surname:
6. Your date of birth:
4. First name(s):
Mr. Mrs. Ms. Other
2. Your Title: (insert an ‘X’ or
specify)
5. Your birth surname:
8. Your telephone number:
Contact Details
Application form for
Part Time Education Option
Please use BLOCK LETTERS and BLACK INK and complete all questions.
Visit www.gov.ie for more information.
I wish to apply for the Part-time Education Option. I understand that I must continue to satisfy the
conditions of being available for and genuinely seeking work. I understand that if I am offered work
while on the course I will be expected to accept the job offer. I understand that if I am on a DSP
payment which is time limited such as Jobseekers Benefit, it may run out whilst pursuing this course. I
declare that all the information I have given is accurate and I will notify the department when my means
or circumstances and/or those of my spouse, civil partner or cohabitant change.
Warning: If you make a false statement or withhold information, you may be
prosecuted leading to a fine, a prison term or both.
Declaration
MOBILE
LANDLINE
D D M M Y Y Y Y
7. Your address:
9 . Your email address:
Signature (not block letters)
Date:
D D M M Y Y Y Y
Only fill in this form if you are getting Jobseeker’s Allowance or Jobseeker’s
Benefit and are seeking permission to take a part-time course.
Part 1
PTEO 1
Data Classification R
Social Welfare Services

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