Equal Opportunities Monitoring Form

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<p>Equal Opportunities Monitoring FormThis form is used to enable us to monitor diversity, and will be detached from the Application Form. It wouldhelp us to promote equality of opportunity if you answer this form in full but, if you would prefer not toanswer a question(s), you may leave a question(s) blankYour DetailsTitle First Names SurnameAddressPostcodemail address!aytime telephone numberEvening telephone numberNotice period required or current !ob"here did #ou see this post advertised$%ealth &amp;please give ull details o #our absences rom 'or( in the last )* months due to illhealth+Ethnic Origin,"ow would you classify your ethnic ori#in$%lack %ritish %lack African %lack &amp;aribbean Asian %ritishAsian 'ther (hite 'ther (please state))))))))))Disabilit#,The Disability Discrimination Act 1995 defnes disability as A physical or mental impairment whichhas a substantial and long term adverse efect on a persons ability to carry out normal day to dayactivities The disability could be physical! sensory or mental and must be e"pected to last at least1# months$!o you have a disability as de*ned by the !isability !iscrimination Act$+,-.'!o you require any assistance to enable you to attend interview e.#. si#nin#$+,-.'- #es. 'hat t#pe o assistance$Applicants withadisabilityareinvitedtocontact us inconfdenceat anypoint duringtherecruitment processtodiscussstepsthat couldbeta%entoovercomeoperational di&amp;cultiespresented by the 'ob! or i( any ad'ustments or support are re)uiredDeclaration%ave #ou ever been convicted o a criminal o/ence$ YES/NO- #es. please give details &amp;e0cept or convictions regarded as spent under the 1ehabilitationo O/enders Act )234+- declare that the details contained in this application are correct to the best o m# (no'ledgeandinparticular that- havenot omittedan#material actsthathaveabearingonm#application5Signed Dated,DD6MM6 YY/a#e 0 of 0O7ce use onl#Application received !!- 11- ++&amp;hecked by2Application no2.</p>