Equality and Diversity Monitoring Form York CVS is committed to encouraging diversity and ensuring equal opportunities in everything that we do, both internally and externally. By completing this form you help us to monitor and improve accessibility for people of any race, gender, age, ability, religion or sexual orientation. You do not have to answer all of these questions if you do not wish. This form will be treated anonymously and confidentially in accordance with the Data Protection Act 1998. Age Gender Female Male Other Prefer Not To Say Sexual Orientation Heterosexual Homosexual Bisexual Other Prefer Not To Say Ethnicity British Asian English Black Irish Chinese Scottish Mixed Welsh White European Other Non-European Prefer Not To Say Religion/Belief Atheist Islam Buddhism Judaism Christianity Sikhism Hinduism Other Prefer Not To Say Are you currently Yes No employed? Prefer Not To Say The Equality Act 2010 defines disability as somebody who Yes No a physical or mental impairment has a substantial “has and long-term adverse effect on his ability to carry out Prefer Not To normal day-to-day activities”. Do you consider you have a Say disability under this definition? If YES, please tick all Physical/mobility Learning difficulties impairments which apply Visual Long-standing illness/ to you Hearing health condition Mental health condition Prefer Not To Say
Equality and Diversity Monitoring Form York CVS is committed to encouraging diversity and ensuring equal opportunities in everything that we do, both internally and externally. By completing this form you help us to monitor and improve accessibility for people of any race, gender, age, ability, religion or sexual orientation. You do not have to answer all of these questions if you do not wish. This form will be treated anonymously and confidentially in accordance with the Data Protection Act 1998. Age Gender Female Male Other Prefer Not To Say Sexual Orientation Heterosexual Homosexual Bisexual Other Prefer Not To Say Ethnicity British English Irish Scottish Welsh European Non-European Asian Black Chinese Mixed White Other Prefer Not To Say Religion/Belief Atheist Buddhism Christianity Hinduism Islam Judaism Sikhism Other Prefer Not To Say Are you currently employed? Yes No Prefer Not To Say The Equality Act 2010 defines disability as somebody who “has a physical or mental impairment has a substantial and long-term adverse effect on his ability to carry out normal day-to-day activities”. Do you consider you have a disability under this definition? Yes No Prefer Not To Say If YES, please tick all impairments which apply to you Physical/mobility Visual Hearing Mental health condition Learning difficulties Long-standing illness/ health condition Prefer Not To Say
York-CVS-Job-Application-Form-FINAL.docx