Equal Opportunities Monitoring

First & Last Name:

Date of Birth: 

Post applied for:

Ethnic Group please indicate below

White	Mixed	Asian or Asian British
British	White and Black Caribbean	Indian
Irish	White and Black African	Pakistani
Any other White Background	White and Asian	Bangladeshi
	Any other Mixed Background	Any other Asian Background
Black or Black British	Chinese or Other Ethnic Group
Caribbean	Chinese
Africa	Other
Any other Black Background
Gender	Disability
Female               Male	Are you disabled?    Yes           No

If disabled, what access arrangements, adjustments or adaptations would help you?

Please see further information regarding disability on the website.   

ELIGIBILITY TO WORK

Are you eligible to work in the UK?  Yes/ No

Do you require a work permit to work in the UK? Yes/No

WORKING WITH VULNERABLE PEOPLE

Jobs involving work with children are exempt from the provisions of the Rehabilitation of offenders Act 1974. 

You are required to state whether or not you have any convictions, or there are any criminal charges or summonses pending, against you.  This applies whether or not your conviction is regarded as “spent”. 

You will also be checked for convictions by the Criminal Records Bureau.  A conviction will not necessarily be a bar to employment.

 Have you ever been disqualified from working with children or vulnerable people? Yes/No                

 Do you have a conviction or caution or actions pending?   Yes/No