Application Form
Personal Details


MaleFemale


Disability AllowanceIllness BenefitInvalidity PensionFree Travel PassJob Seekers Allowance


EmailPhonePost

Diagnosis And Professional Contacts


Medical History


NoYes

Education And Qualifications

Training And Development

Employment History


UnemployedEmployed


NoYes

Supporting Information

Allowances Needed

Declaration And Confidentiality Agreement
  1. Personal information given to a Specialisterne worker is accessible to the relevant other Specialisterne workers.
  2. All personal information made available to Specialisterne Ireland by candidates is confidential and will only be used in the context of the work of promoting the interests of the candidate.
  3. Personal information includes all written and oral communications from candidates, family members, professionals, official sources or acquaintances.
  4. In the course of seeking employment for candidates it will be necessary to pass some personal information to other agencies (e.g. employers etc.). Examples of this may include:
    • CVs
    • Current employment status
    • Certificate of diagnosis
    • Relevant medical information
    • Other relevant information
    • The communication of any confidential information to another party will be on a need to know basis. The disclosure of any item(s) of confidential information will only be done with the agreement of the candidate.
  5. On occasion Specialisterne may use anonymised information for the purposes of research, or promoting the goals, aims and interests of Specialisterne and the ASD community.
  6. The policy of confidentiality will not apply in the following circumstances:
    • In the event that Specialisterne is aware or believes that a candidate is in danger from their own actions or the actions of others
    • or that a candidate poses a threat to others
    • or that a disclosure of sexual abuse is made to Specialisterne
    • In these circumstances Specialisterne reserves the right to communicate the relevant information to the appropriate statutory authorities (e.g. HSE, Garda Siochana etc.)