Common Youth

Confidential

Employment monitoring

Common Youth wishes to ensure the fair and equitable treatment of all job applicants and to meet the requirements of equal opportunities legislation. The information on this form will only be used to monitor recruitment and will not be used in the selection process.

Post applied for: CEO
Where did you see it advertised?
Date of birth
/
Sex( ) Female
( ) Male
Disability
Common Youth wishes to encourage people with disabilities to apply for jobs. All information will be treated in confidence. For employment purposes, a disabled person is defined as a person with a physical, sensory or mental impairment which has a substantial and long- term effect on his or her ability to carry out normal day to day activities.
Using this definition, do you consider yourself to have a disability? Please tick.
( ) Yes ( ) No
If yes, what is the nature of your disability? /
Ethnic Group
Please tick the box that describes your ethnic origin.
( ) Bangladeshi
( ) Black African
( ) Black Caribbean
( ) Chinese
( ) Indian
( ) Pakistani
( ) White
( ) Other - ______
Are you a member of a mixed ethnic group?
( ) Yes ( ) No
Are you a member of the Irish Traveller Community? ( ) Yes ( )No

For use in Northern Ireland only

Community background (Fair Employment and Treatment (NI) Order 1998). Please tick.
( ) Roman Catholic ( ) Protestant ( ) Other
I understand that by completing this form that I give my explicit consent under the Data Protection Act 1998 for Common Youth to retain this information for six months after the end of the recruitment process. The purpose of retaining this information is to monitor the success or otherwise of Common Youth’s recruitment and selection policy in attracting potential employees who represent all sectors of the community.
Signed ______Date ______