Recruitment Monitoring
The completion of this form is voluntary; however we appreciate it when a candidate takes the time and trouble to do so. This information helps us to monitor and improve our equal opportunities policies and procedures.
Any decisions are made in relation to short listing candidates are based purely on merit and do not take into account any information given on this form.
If you wish to assist us but are uncomfortable with answering all questions then you may select sections that you wish to answer.
Please complete in ink and tick boxes where appropriate.

PERSONAL DETAILS
Name:
Position Applied for:
Date of Birth:
Gender:

Male:

Female:

Title: Mr
Mrs
Other..........

Miss

Ms

SEXUAL ORIENTATION
Heterosexual:
Homosexual:
Bisexual:

DEPENDENTS
No. Of Children under 16

DISABILITY
The Disability Discrimination Act 1995 defined a person as having a disability if he/she has a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities. Do you have a disability as defined above?

Yes

No

If the above does not apply to you and you consider yourself to have a disability please tick here

1

ETHNIC ORIGIN
Choose one section from (A) to (E) then tick the appropriate box to indicate your cultural background. These categories are based on the 2001 Census.

A: WHITE
British
Irish
Other (please specify)..........

C: ASIAN OR ASIAN BRITISH
Indian
Pakistani
Bangladeshi
Other (please specify)..........