Monitoring Form

MONITORING FORM

The Royal Central School of Speech and Drama is committed to Equal Opportunities, irrespective of age, background, colour, disability, domestic / family circumstance, gender, nationality, political belief, race, religious belief, sexual orientation, trade union, or other external activity or other irrelevant distinction.
Although there is no legal obligation for you to provide the information requested below, any information you do provide will assist us in actively promoting equality and diversity within the institute and provide helpful information to avoid discrimination on these grounds.
Your personal details will be used for internal statistical purposes and for anonymised reporting to external organisations such as the Higher Education Funding Council and the Higher Education Statistical Agency. You will not be contacted as a result of any information supplied on this form.
The information supplied will be treated in confidence and will not be used as part of the selection process. This monitoring form will be separated from the application form on receipt at The Royal Central School of Speech and Drama and will not be seen by the recruitment and selection panel.
The form complies with the requirements of the Data Protection Act 1998. Information is also being collected for monitoring purposes as recommended in the Sex Discrimination Act 1975, the Disability Discrimination Act 1995, the Race Relations Act 1976 and as amended in2000, and in line with the implementation of the Employment Equality (Religion or Belief) Regulations 2003 and (Sexual Orientation) Regulations 2003.
Post applied for /

Associate Musical Director

How did you learn of this vacancy
Name of publication \ website
Date of birth / Nationality
Gender / Male Female

ETHNIC MONITORING

White / White(10) Gypsy or Traveller (15)
Black or Black British / Caribbean (21) African (22)
Other Black background (29) (please specify)
Asian or Asian British / Indian (31) Pakistani (32) Bangladeshi (33)
Other Asian background (39) (please specify)
Chinese / (34)
Mixed / White & Black Caribbean (41)
White & Black African (42) White & Asian (43)
Other Mixed background (49) (please specify)
Other / Other Ethnic background (80)
DISABILITY MONITORING
Do you consider yourself to be a disabled person? Please insert a “Y” in the relevant box below:
No known disability (0)
Two or more impairments and/or disabling medical conditions (8)
A specific learning difficulty such as dyslexia, dyspraxia or AD(H)D (51)
General learning disability (such as Down's syndrome) (52)
A social/communication impairment such as Asperger's syndrome/other autistic spectrum disorder (53)
A long standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy (54)
A mental health condition, such as depression, schizophrenia or anxiety disorder (55)
A physical impairment or mobility issues, such as difficulty using arms or using a wheelchair or crutches (56)
Deaf or serious hearing impairment (57)
Blind or a serious visual impairment uncorrected by glasses (58)
A disability, impairment or medical condition that is not listed above (96)
If you do not wish to provide the information requested (97)

RELIGION OR BELIEF

Please specify
If you do not wish to provide the information requested please tick this box / No religion or belief
SEXUAL ORIENTATION
Please specify

If you do not wish to provide the information requested please tick this box

CONFLICT OF INTEREST
For the avoidance of conflicts, have you hadany business dealings with, or are related to, any memberof staff of the School / Yes / No
If yes please provide details:
RESTRICTIONS TO WORK OR REMAIN IN THE UK
Do you have any restrictions on your right to
work or remain in the UK / Yes / No
If yes, please give details:
Do you require sponsorship to work in
the UK / Yes / No
If yes, please give details:
REHABILITATION FOR OFFENDERS
In accordance with the Rehabilitation for Offenders
Act 1974, have you ever had a criminal conviction,
including spent convictions / Yes / No
If yes, please provide full details.
SPECIAL REQUIREMENTS
If you are invited to attend for assessment or interview,
do you have any special requirements that we should be
aware of / Yes / No
If yes, please provide details:
DECLARATION
I confirm that the information supplied by me on the Monitoring Form is correct.
I understand that the information provided by me would be treated as confidential.
Name / Date
Signed
Please note that if you submit your application form electronically (by email) should you
be selected for interview thereafter you will be asked to sign your application during the
interview process.

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