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Embed code for: Equal Opportunities Monitoring Form (MASTER)
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Headway Equal Opportunities Monitoring
Headway is committed to eliminating discrimination in employment practices. It is the organisation’s aim to select on the basis of suitability and capability to do the job and to ensure all candidates are treated solely on the grounds of merit. Please assist us to monitor our Equal Opportunity Policy, by completing the details requested below.
Post applied for: ___Manager___m_________________________________________________________
Full name: ______Helen Oliver____________________ Date of Birth: _22/07/69____________________ Age: ____45____
Previous name (if applicable): ________Crewe________________________________________________
Where did you learn of this vacancy?
(If advertisement, please state in which publication)
1 Gender Please tick the following: Male Female
2 Sexual Orientation (completion of this section is optional)
Please tick one of the following
Towards persons of the same sex (lesbian and gay men)
Towards persons of the opposite sex (heterosexual)
Towards persons of the same and opposite sex (bisexual)
3 Disability Do you have a disability: Yes No
If yes, what is the nature of your disability?
Sensory Mobility Physical co-ordination Mental health
Learning Disability Other
Will you require any support in the workplace? Yes No
If yes, please indicate what support you will require:
4 Ethnic Origin
Please tick one of the following, which you fee most accurately, describes your ethnic origin.
Asian or Asian British
Black or Black British
Any other white background
White & black Caribbean
White & Black African
White & Asian
Any other mixed background
Any other Asian background
Any other Black background
Other Ethnic Group
Any other ethnic groups
OFFICE USE ONLY:SHORTLISTED ( ) INTERVIEWED ( ) APPOINTED ( )