4. Do you consider yourself to have a disability? (Age UK Barnsley is committed to ensuring that people with disabilities are supported and encouraged to apply for employment with Age UK Barnsley and to achieve progress in that employment. This question helps us to assess our success in achieving this aim). Yes No If you wish to provide any additional details please do so below: ……………………………………………………………………………………………… ……………………………………………………………………………………………… NB. The Disability Discrimination Act 1995 defines a disability as: physical or mental impairment which has a substantial and long-term (lasting more than 12 “a months) adverse effect on your day to day living. If you wish you may disclose information about yourself in this section: Religion: ………………………………………………… Sexual Orientation: ……………………………………. Is there anyone who relies on you for day to day care and attention? (This question is recommended by the Equal opportunities Commission and will help us to review our flexible working policies) Yes No If Yes, are they: a) Children: aged 0.-5 Date(s) of Birth: ……………………… Date(s) of Birth: ………………………………………….. Date(s) of Birth: ………………………………………….. and/or A family member / partner (please specify): ………………………… This information will be used solely by the HR Department for monitoring purposes and will be treated as confidential. Thank you for your co-operation Registered Charity Number 1144123
4. Do you consider yourself to have a disability? (Age UK Barnsley is committed to ensuring that people with disabilities are supported and encouraged to apply for employment with Age UK Barnsley and to achieve progress in that employment. This question helps us to assess our success in achieving this aim). Yes No If you wish to provide any additional details please do so below: ……………………………………………………………………………………………… ……………………………………………………………………………………………… NB. The Disability Discrimination Act 1995 defines a disability as: “a physical or mental impairment which has a substantial and long-term (lasting more than 12 months) adverse effect on your day to day living. If you wish you may disclose information about yourself in this section: Religion: ………………………………………………… Sexual Orientation: ……………………………………. Is there anyone who relies on you for day to day care and attention? (This question is recommended by the Equal opportunities Commission and will help us to review our flexible working policies) Yes No If Yes, are they: a) Children: aged 0.-5 Date(s) of Birth: ……………………… Date(s) of Birth: ………………………………………….. Date(s) of Birth: ………………………………………….. and/or A family member / partner (please specify): ………………………… This information will be used solely by the HR Department for monitoring purposes and will be treated as confidential. Thank you for your co-operation Registered Charity Number 1144123