OPPORTUNITIES MONITORING FORM Post Applied For Ref No. Surname or Family Name Former Name(s) names Do you consider yourself to have a disability? (i.e. a physical or mental impairment which has a substantial and long-term adverse effect on your Yes / No ability to carry out normal day-to-day activities) (Delete as appropriate) If you have a disability what equipment, adaptations or adjustments to working conditions would assist you in carrying out your duties? What is your gender? (Delete as appropriate) Female / Male Which of the following best describes your Ethnic origin? These categories are based on the 2001 census. Your answer must be within this list: White - British / White - Irish / White - Other / Mixed - White & Black Caribbean / Mixed - White & Black African / Mixed - White & Asian / Mixed - Other Mixed Group / Asian or Asian British - Indian / Asian or Asian British - Bangladeshi / Asian or Asian British - Pakistani / Asian or Asian British - Other Asian / Black or Black British - Caribbean / Black or Black British - African / Black or Black British - Other Black background / Chinese / Any other ethnic group
OPPORTUNITIES MONITORING FORM Post Applied For Ref No. Surname or Family Name Former Name(s) names Do you consider yourself to have a disability? (i.e. a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities) (Delete as appropriate) Yes / No If you have a disability what equipment, adaptations or adjustments to working conditions would assist you in carrying out your duties? What is your gender? (Delete as appropriate) Female / Male Which of the following best describes your Ethnic origin? These categories are based on the 2001 census. Your answer must be within this list: White - British / White - Irish / White - Other / Mixed - White & Black Caribbean / Mixed - White & Black African / Mixed - White & Asian / Mixed - Other Mixed Group / Asian or Asian British - Indian / Asian or Asian British - Bangladeshi / Asian or Asian British - Pakistani / Asian or Asian British - Other Asian / Black or Black British - Caribbean / Black or Black British - African / Black or Black British - Other Black background / Chinese / Any other ethnic group
STEP-Non-Teaching-Staff-Application-Heathfield.docx