Please complete the Equal Opportunities Monitoring form to enable us to monitor the effectiveness of our equal opportunities policy in regards to our applicants. Information will be treated in strict confidence and used only for monitoring purposes and will not form any part of the assessment process. Data is collected in accordance with the requirements of the Data Protection Act and the Code of Practice issued by the Chartered Institute of Personnel and Development. Personal and post details Male: Female: Name: Date of birth: Sex: Vacancy reference number: Post applied for: Marital status (please tick) Single: Civil Partnership: Widow/Widower: Separated: Married: Living with Partner: Divorced: Do not wish to disclose: Disability (please tick) Under the Disability Discrimination Act 2005 the definition includes anyone with a or mental impairment which “physical has a substantial, long term, adverse effect on their ability to carry out normal day to day activities”. This can include cancer or other such long term illnesses. Yes: No: Do not wish to disclose: Under this new definition do you consider yourself to have a disability? If yes, which of the following best describes your disability: Speech: Visual (not including wearing glasses or contact lenses): Hearing: Co-ordination, dexterity or mobility: Mental health: Other physical or mental conditions (please specify): Learning difficulties: Religion of belief (please tick) Catholic: Jain: Church of England: Buddhist: No religion: Jewish: Muslim: Other: Orthodox Jewish/Charedi: Sikh: Please specify: Do not wish to disclose: Caring responsibilities (please tick) Yes: No: Do not wish to disclose: Do you have a carer responsibility for anyone? Sick: Disabled: Elderly: If yes, are they: Adults: Children under 16: Sick: Disabled:
Please complete the Equal Opportunities Monitoring form to enable us to monitor the effectiveness of our equal opportunities policy in regards to our applicants. Information will be treated in strict confidence and used only for monitoring purposes and will not form any part of the assessment process. Data is collected in accordance with the requirements of the Data Protection Act and the Code of Practice issued by the Chartered Institute of Personnel and Development. Personal and post details Name: Date of birth: Sex: Male: Female: Post applied for: Vacancy reference number: Marital status (please tick) Single: Civil Partnership: Widow/Widower: Separated: Married: Living with Partner: Divorced: Do not wish to disclose: Disability (please tick) Under the Disability Discrimination Act 2005 the definition includes anyone with a “physical or mental impairment which has a substantial, long term, adverse effect on their ability to carry out normal day to day activities”. This can include cancer or other such long term illnesses. Under this new definition do you consider yourself to have a disability? If yes, which of the following best describes your disability: Yes: No: Do not wish to disclose: Speech: Hearing: Mental health: Learning difficulties: Visual (not including wearing glasses or contact lenses): Co-ordination, dexterity or mobility: Other physical or mental conditions (please specify): Religion of belief (please tick) Catholic: Church of England: Jewish: Orthodox Jewish/Charedi: Do not wish to disclose: Buddhist: Muslim: Sikh: Jain: No religion: Other: Please specify: Caring responsibilities (please tick) Do you have a carer responsibility for anyone? Yes: No: Do not wish to disclose: If yes, are they: Adults: Children under 16: Sick: Disabled: Elderly: Sick: Disabled:
SC3848%20Application%20Form.docx