The Trust is an Equal Opportunities employer. The Trust operates a policy, the aim of which is to ensure that unfair discrimination does not take place in recruitment. In order to help the Trust monitor the effectiveness of this policy (and for no other reason), you are asked to provide the information requested below. This information is confidential and does not form part of your application. This slip will be detached from your application form when it is received, and the information will not be taken into account when considering the application.

Post Applied For

Personal Details:

Title / Address
First Name
Surname
Previous Name (s) / Postcode
Date of Birth / Telephone
Gender / Mobile
Email

Disability:

Do you consider yourself to have a disability, impairment, health condition or learning difference?

Yes o No o Unsure o

Please describe your disability, impairment or health condition.

Age

To which age band do you belong? (Tick one box only)

16 -19 q / 20 – 24 q / 25 – 29 q / 30 – 34 q / 35 – 39 q / 40-44
45-49 q / 50-54 q / 55-60 q / 60+ q

Ethnic Origin:

White: / Mixed/ Multiple Ethnic Groups :
Scottish / English / Welsh / Northern Irish / British / White and Black Caribbean
Irish / White and Black African
Gypsy or Irish Traveller / White and Asian
Any other White background, please describe / Any other Mixed / Multiple ethnic background, please describe
Asian / Asian British / Black / African / Caribbean / Black British
Indian / African
Pakistani / Caribbean
Bangladeshi / Any other Black / African / Caribbean background, please describe
Chinese
Any other Asian background, please describe
Other Ethnic Group
Arab / Any other, please describe:

Religion:

No Religion / Buddhist
Christian (includes C of E, Catholic, Protestant and other Christian denominations) / Hindhu
Jewish / Muslim
Catholic / Sikh
Other (Please Specify) / I prefer not to state my religion

Please place this form in a separate envelope and return with your application to:

Recruitment

The Jon Egging Trust

The Old Bakehouse

Ufton Fields

Ufton

Leamington Spa

CV33 9NZ

Or email:

Any further enquiries can be made about this vacancy by calling 07885 911187 in the first instance

THANK YOU FOR YOUR CO-OPERATION

All information provided on this form will be dealt with in accordance with the Data Protection Act 1984, amended 1998. This information may be computerised and used for administrative purposes within The Trust. All personal information computerised by The Trust has to be registered and may only be used and disclosed as described in the Data Protection Register.