Equal Opportunities and Diversity Monitoring Form

We are actively committed to safeguarding and promoting the welfare of children, young people and any vulnerable groups within the College community. We value our diverse College community and are actively committed to promoting equality and diversity in all areas of College life; as such, applications are welcomed from all sections of the community. We expect all our staff and volunteers to share these commitments.

To help ensure that this policy is put into practice, it is important that you complete the details below and return this form with your application form. These details will be used by the Personnel and Payroll Section for monitoring purposes, to make reasonable adjustments to the selection process (if applicable), and to establish your personnel and payroll computerised record and personnel file. The College has made a commitment to interview all candidates with a disability, providing they meet all the essential requirements of the post.

Information provided on this form will not be shared with the shortlisting panel. By signing this form you are giving consent for us to process this data about you.

PERSONAL DETAILS
Surname: / Click here to enter text. / Forename(s): / Click here to enter text.
Other/previous names: / Click here to enter text. / Date of birth(dd/mm/yy): / Click here to enter text. / Age: / Click here to enter text.
Contact Details / Marital status: / Choose an itemMarriedDivorcedSeperated but legally marriedWidowedIn a registered same-sex civil partnership (SSCP)Separated but still legally in a SSCPFormerly in SSCP which is now dissolvedSurviving partner of SSCPNever married or registered a SSCP / Gender: / Choose an item.MaleFemale
Address: / Click here to enter text. / Do you consider yourself to have a disability? / Choose an item.YesNo
If Yes, please specify the nature of your disability below:
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Is there anything else we need to know about your disability in order to offer you a fair selection process (e.g. car parking, access e.t.c)? Please detail below:
Postcode: / Click here to enter text. / Click here to enter text.
Home tel: / Click here to enter text. / What is your religion/belief?
Work tel: / Click here to enter text. / Choose an itemNo religionChristian (All Denominations)MuslimSikhJewishBuddhistHinduAny other (please specify)Do not wish to specify / If other, please specify: Click here to enter text.
Mobile tel: / Click here to enter text. / How would you describe your ethnic origin?
Email: / Click here to enter text. / Choose an itemWhite BritishWhite Republic of IrelandWhite: Gypsy or Irish TravellerWhite other (please specify)Mixed: White and Black CaribbeanMixed: White and Black AfricanMixed: White and AsianOther mixed (please specify)Asian or Asian British: IndianAsian or Asian British: PakistaniAsian or Asian British: BangladeshiAsian or Asian British: ChineseOther Asian or Asian British (please specify)Black African or Black British: AfricanBlack African or Black British: CaribbeanOther Black Heritage (please specify)Other ethnic group: ArabAny other ethnic group (please specify)
National Insurance No: / Click here to enter text. / If other, please specify below:
Which of the following best describes you? Please select below: / Click here to enter text.
Choose an itemBisexualHeterosexualGay/ LesbianI do not wish to disclose this
Do you have a family or close relationship to any employees or governors of Henley College Coventry? / Choose an item.YesNo
If yes, please state name(s) and relationship(s): / Click here to enter text.
Are you permitted to work in the UK?
NB: You will be required to provide documentary evidence of eligibility to work in the UK in accordance with the Asylum and Immigration Act 2006. / Choose an item.YesNo
How did you find out about the vacancy for which you are applying? / Choose an itemAdvertisement (please specify)Website (please specify)JobcentreCasual enquiryInformation from existing employeeSchool/ College careers serviceCollege websiteWord of mouth
If advertisement or website, please state which publication or website: / Click here to enter text.
Have you ever had any personal involvement in any issues regarding safeguarding or promoting the wellbeing of children, young people or vulnerable groups that may affect your suitability to work with such groups?
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Personnel Use Only:
Candidate Reference Number:


Equal Opportunities and Diversity Monitoring Form - continued

QUALIFICATIONS
Please provide a list of your qualifications as detailed on the Formal Education section of the Application Form and the date on which they were obtained
Qualifications / Date Obtained (mm/yyyy)
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REHABILITATION OF OFFENDERS
The Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 provides that all convictions, criminal charges or summonses pending against you, of whatever nature and whenever they were committed, must be revealed when applying for this position. The College is therefore entitled to take into account, when considering you for appointment, any criminal convictions, cautions, bind-overs, reprimands or warnings that you may have had, or which are pending, including those for which other purposes are ‘spent’ under the provision of the Act. Failure to do so could result in any offer of employment being withdrawn, or, in the event of employment, disciplinary action being taken by the College that could lead to your dismissal. However, amendments to the Exceptions Order 1975 (2013) provides that certain spent convictions and cautions are ‘protected’ and are therefore not subject to disclosure. You are therefore only required to provide information about spent and unspent convictions, cautions, bind-overs, reprimands or warnings that are not ‘protected’, including pending criminal convictions. If you wish, you may disclose such details in a sealed envelope marked ‘confidential’. Successful applicants will also be required to undertake an enhanced Disclosure and Barring Service (DBS) disclosure (criminal record check), if applicable. Any information given will be treated in the strictest confidence.
Do you have a criminal conviction, caution, bind-over, reprimand and/or warnings, including any pending criminal prosecutions, which are not ‘protected’ by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)?
Choose an item.YesNo
If yes, please give details below.
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Click here to certify that the above information is correct
Date: /
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Click below to certify that you are not disqualified from working with children or subject to any sanctions imposed by a regulatory body.
Date: / Click to enter date.
If you are unable to sign this declaration, please give details below:
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We are actively committed to safeguarding and promoting the welfare of children, young people and any vulnerable groups within the College community. We value our diverse College community and are actively committed to promoting equality and diversity in all areas of College life. Applications are welcomed from all sections of the community. We expect all our staff and volunteers to share these commitments.

Application for Appointment

Please complete this form accurately and in full as it forms the initial stage of our selection procedure. The information on this form will be treated as confidential to the College.

Please do not submit CVs in place of completing this form in full or your application will not be considered. Please read the guidance notes prior to completing your application form.

Job title of post for which you are applying: / Job ref. no:
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Present Employment
Name and address of employer: / Summary of key duties/responsibilities:
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Post held: (if not in employment please give brief outline of current situation/occupation): / Date of appointment: / Click here to enter text. / Period of notice required: / Choose an item1 week2 weeks3 weeks1 month2 months3 months3 months +
Click here to enter text. / Present salary: / Click here to enter text. / Status: / Choose an itemFull-timePart-time
Previous Employment (most recent first)
Dates / Employer / Position held and summary of responsibilities / Salary/grade / Reason for leaving/change
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Formal Education (Secondary education first)
School/College/University Establishment / Full-Time or Part-Time / Qualifications (including level and grade).
Please ensure you complete the ‘Qualifications: Date Obtained’ section on the Equal Opportunities and Diversity Monitoring section of the application form. / Subjects
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Teaching Qualifications and/or Assessor Awards (if applicable)
Please detail below Teaching/Assessor Qualification/Award(s) and date achieved. If you are working towards a teaching qualification and/or assessor award(s), please indicate this below and state when you expect to achieve the qualification/award(s).
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Please describe your QTLS/ATLS Status (if applicable): / Choose an itemQTLS status acheivedWorking towards QTLS statusQTLS/ATLS status not applicableATLS status acheivedWorking toward ATLS status
Please detail date QTLS/ATLS achieved or expected to be achieved if working towards: / Click here to enter text.
Institute for Learning membership number (if applicable): / Click here to enter text.
Details of Membership of Professional Institutions or Learned Societies
Name of Body/Membership / Grade of membership / Date of election
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Relevant Training/Continuing Professional Development
Training Provider/Organising Body / Full-time or Part-time / Qualification/Training course title / Date attended/completed (mm/yyyy)
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