IE
S.I. No. 575/1935 - Unemployment Assistance (Application For Assistance Regulations) (Amendment) Order, 1935.
Statutory Text (3 Articles)
1. Name of Applicant............................................................ ............................................................
Address............................................................ ............................................................ ..................
II. PARTICULARS OF DEPENDANTS.
No.
Surname
Christian Name(s)
Relationship
Date of Birth
Whether employed (Answer " Yes " or " No ")
Day
Month
Year
III.—(
a
) If your wife is named in Paragraph II, state
(i) Wife's maiden name............................................................ ...............................................
(ii) Is she living with you ?............................................................ ........................................
(iii) Date and place of Marriage............................................................ .................................
(iv) Does she work (otherwise than at her household duties) for wages or other remuneration?
............................................................ ..............
(v) Give particulars of any occupation followed by her.....................................................
(vi) What pension or income, if any, has she ?............................................................ .......
(
b
) If your husband is named in Paragraph II, state
(i) Date and place of Marriage............................................................ ....................................
(ii) Is he living with you ?............................................................ ............................................
(iii) Is he supported by you ?............................................................ ......................................
(iv) Why is he unable to support himself ?............................................................ ...............
(
c
) If your children, step children or children to whom you have placed yourself in
loco parentis
are named in Paragraph II, state
(i) Is each of them wholly or mainly supported by you ?....................................................
(ii) If over 18 years of age why are they unable to support themselves ?
............................................................ .........
(iii) Which of them are not your children or step children ?...............................................
(iv) What responsibility have you undertaken for these ?.................................................
(
d
) If your mother is named in Paragraph II, state
(i) Is she wholly or mainly supported by you ?............................................................ .........
(ii) Why is she unable to support herself ?............................................................ ................
(iii) Is her husband alive ?............................................................ ..............................................
(iv) Why is he unable to support himself ?............................................................ ................
(
e
) If your father is named in Paragraph II, state
(i) Is he wholly or mainly supported by you ?............................................................ ...........
(ii) Why is he unable to support himself ?............................................................ .................
(
f
) If your brothers or sisters are named in Paragraph II, state
(i) Are they wholly or mainly supported by you ?............................................................ ....
(ii) Is either of your parents dead ?............................................................ ..............................
(iii) Why are they unable to support themselves ?............................................................ ...
(g) Do any other persons contribute in any way to the support of any of the persons named in Paragraph II and, if so, to what extent ?
............................................................ ......
(h) Do all the persons named in Paragraph II reside with you ? If not, state with whom they reside and what support you give them
............................................................ ......
(i) Are any of the persons named in Paragraph II applying for Unemployment Benefit or Unemployment Assistance ? If so, give particulars
............................................................ ......
(j) Give the following particulars in respect of any persons under 18 years of age named in Paragraph II
............................................................ ......
Name of Person
Names and Addresses of employers in last three months
Period
Occupation
From
To
DECLARATION.
I, the undersigned, hereby declare that the persons named in this application are dependants within the meaning of
Section 4
of the
Unemployment Assistance (Amendment) Act, 1935
; that to the best of my knowledge and belief no other person is claiming them as dependants under the said Act, and that all the statements made by me on this form are true. I undertake to notify the Local Officer of the Department of Industry and Commerce if, at any time while I am in receipt of Unemployment Assistance under the Unemployment Assistance Acts, 1933 and 1935, any of the above particulars cease to be true.
*Signature............................................................ ................................................
*Signature of Witness to " Mark "............................................................ ........
Address of Witness to " Mark "............................................................ ...........
Date............................................
* If you are unable to write, your mark should be affixed and duly witnessed.
CONFIRMATION (See Note).
The particulars stated in this application are true and correct to the best of my knowledge and belief.
Signature............................................................ ............................................
Description............................................................ .........................................
Address............................................................ ..............................................
............................................................ ...............................................
Date....................................
NOTE.—The confirmation must be signed by one of the following : A Local Peace Commissioner ; a Barrister or Solicitor ; a Minister of Religion ; a Registered Medical Practitioner ; a Schoolmaster or Teacher of a day school ; a Home Assistance Officer ; a member of a County Board of Health ; a County, City, Borough or Urban District Councillor ; a Secretary or other responsible local representative of the Applicant's Trade Union.
SECOND SCHEDULE.
UNEMPLOYED REGISTER.
I hereby declare in respect of the day in the week ending on the date shown below under which my signature or mark or initials are inserted that :—
(i) I am unemployed, capable of, available for and genuinely seeking, but unable to obtain employment suitable for me ;
(ii) I comply with all the statutory conditions specified in the Unemployment Assistance Acts, 1933 and 1935 ;
(iii) I am not disqualified for receiving Unemployment Assistance under the Unemployment Assistance Acts, 1933 and 1935 ;
(iv) My dependants within the meaning of the Unemployment Assistance Acts, 1933 and 1935, are
..................................Wife, .............................Husband, ...........................Others.
Week ending............................................................ ................................................
Wednesday
Thursday
Friday
Saturday
Monday
Tuesday
2. The Unemployment Assistance (Application for Assistance Regulations) Order, 1934, is hereby amended by the substitution of the First and Second Schedules set out in the Schedule hereto for the First and Second Schedules respectively now contained in the said Order.
By Order of the Minister for Industry and Commerce.
Dated this 28th day of August, 1935.
(Signed) J. J. KEANE,
Chief Employment Officer.
Department of Industry and Commerce.
FIRST SCHEDULE.
APPLICATION FOR UNEMPLOYMENT ASSISTANCE.
I................................................... of............................................... hereby apply for unemployment assistance. I declare that :—
(1) My date of birth is............................................................ ............................................
(2) I was last employed by
(i) Name ............................................................ ...........................................................
(ii) Address ............................................................ .....................................................
(iii) Business of Employer............................................................ .............................
(iv) Capacity in which employed............................................................ .................
(v) From........................................................... to.......................................................
(vi) Foreman, Department or Check No............................................................ .....
(3) I am the person named as the holder of the qualification certificate now delivered by me ;
(4) Since my qualification certificate was issued to me I have not done anything and no change of circumstances or other event has occurred which would invalidate such certificate or would disentitle me to hold such certificate ;
(5) I am unemployed, capable of, available for and genuinely seeking but unable to obtain employment suitable for me having regard to my age, sex, physique, education, normal occupation, place of residence and family circumstances ;
(6) I am not in receipt of or entitled to
(i) a pension under
Section 6
of the
Old Age Pensions Act, 1932
;
(ii) any sickness or disablement allowance under the National Health Insurance Acts, 1911 to 1934 ;
(iii) any benefit under a Special Scheme under the Unemployment Insurance Acts, 1920 to 1933 ;
(iv) any pension under the
Widows' and Orphans' Pensions Act, 1935
.
(7) (i) During the past year I have ordinarily resided at the following address or addresses :—
Address or Addresses
Period of Residence
From
To
(ii) During the past year I have been employed as follows :—
Names of Employers and Addresses at which Employed
Period of Employment
From
To
(8) Particulars of any conviction of any offence under the Unemployment Assistance Acts, 1933 and 1935, within the past three months, and any other conviction, and any other sentence of imprisonment or penal servitude for any term not less than one fortnight within the past three months are set out opposite.
Particulars of such Conviction and Sentence
Date of Conviction
Signature of Applicant............................................................ ...
Date of Signature.........................................................
CONTINUATION OF APPLICATION FOR UNEMPLOYMENT ASSISTANCE
(TO BE COMPLETED BY APPLICANTS WITH DEPENDANTS.)
STATUTORY RULES AND ORDERS. 1935. No. 575.
UNEMPLOYMENT ASSISTANCE (APPLICATION FOR ASSISTANCE REGULATIONS) (AMENDMENT) ORDER, 1935.
THE UNEMPLOYMENT ASSISTANCE (APPLICATION FOR ASSISTANCE REGULATIONS) (AMENDMENT) ORDER, 1935, MADE BY THE MINISTER FOR INDUSTRY AND COMMERCE ON THE 28th DAY OF AUGUST, 1935, PURSUANT TO
SECTION 7
of THE
UNEMPLOYMENT ASSISTANCE ACT, 1933
.
WHEREAS it is expedient in consequence of certain provisions of the
Unemployment Assistance (Amendment) Act, 1935
, that the regulations made by the Unemployment Assistance (Application for Assistance Regulations) Order, 1934, be amended
NOW, THEREFORE, the Minister for Industry and Commerce in exercise of the powers conferred on him by sub-section (1) of
Section 7
of the
Unemployment Assistance Act, 1933
, and of every and any other power him in this behalf enabling, hereby orders as follows, that is to say :—