Autism Family Support Oxfordshire
Registered charity 276494
Application Form
Please type or write in the spaces provided.
We prefer applications to be sent via email, if this is not possible please post applications to the
address at the end of the form.
APPLICATION FOR THE POST OF:
SECTION ONE:
PERSONAL DETAILS
Forename(s):
Surname:
Title:
Home Telephone:
Address including full postcode:
Work Telephone:
Email:
Nationality:
Right to work in the UK
Do you require a work permit to work in the UK?
Yes
No
Please note you will be asked to provide evidence of your right to work in the UK. This is in accordance with the
Asylum and Immigration Act 1996.
Disclosure of Convictions
Please provide details of any unspent convictions:
Please provide details of any spent convictions *:
* This post involves working with children and vulnerable adults.
Any spent convictions are exempt from the provisions of
section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order
1975. Failure to declare convictions as requested may result in terminating employment.
SECTION TWO: EMPLOYMENT HISTORY
Please summarise previous jobs, starting with the most recent. Please elaborate on posts which are most relevant.
CURRENT / MOST RECENT EMPLOYMENT
From
To
Notice required
Job Title
Name and position of Supervisor
Main Responsibilities and Achievements
Employers Name, and location
Current Salary
Reason for Leaving
PREVIOUS EMPLOYMENT
From
To
(MMM/YY) (MMM/YY)
Job Title
Employers Name
Main duties
SECTION THREE: QUALIFICATIONS AND TRAINING
Please list academic education and any professional/work related training you have undertaken which would be
relevant to this post, in chronological order, with most recent listed first
From
To
Qualification/ Course Completed
Subjects Studied
Qualification Achieved
SECTION FOUR: SELECTION CRITERIA
Please refer to the Person Specification and provide specific examples which demonstrate how you meet each
criterion. Please be as specific and relevant as possible. You may use additional sheets if required.
SECTION FIVE:
SUPPLEMENTARY INFORMATION
Please indicate how many days you have been absent from work owing to illness during the last 2 years, and
the number of episodes of absence this represents. Please also give the reasons for any absence.
Recruitment Monitoring
Please specify where you saw this position advertised:
Previous Applications
Have you applied to Autism Family Support Oxfordshire before?
If yes, When and what position?:
What was the result of your application?:
Yes
No
SECTION SIX: REFERENCES
Please give TWO independent referees. One should be your current or most recent employer. If you are not
working please provide details of TWO former Line Managers. If you have never been in employment please
provide details of two people who can confirm that you meet the selection criteria for the job.
1. Most recent employer
2. Professional referee:
Forename(s):
Forename(s)
Surname:
Title:
Surname:
Title:
Organisation:
Organisation
Contact address:
Contact address:
Tel:
Relationship:
Tel:
Email:
Relationship:
Email:
Can we contact your referees before interview?
Yes
No
DECLARATION
I agree that any offer of employment is subject to satisfactory references and clearance checks.
In accordance with the 1998 Data Protection Act I agree that Autism Family Support Oxfordshire (AFSO) can hold
and use personal information about me and for AFSO to keep in touch with me. This information can be stored in
both manual or computer form.
I confirm that information provided on this form and any attachments are to the best of my knowledge correct and
complete. I understand that any information later discovered to be incorrect may result in the termination of any
agreements made.
Signature:
___
Date
If you are applying via email: Please type your name.
Please return the completed Application Form together with the Equal Opportunities form to:
Name:
Gita Lobo
For official use only
Email:
gita@afso.org.uk
S/L  Int  Offer
By post:
Autism Family Support
Thomley Hall Centre
Menmarsh Road
Worminghall
HP18 9JZ
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