CONFIDENTIAL

SHEFFIELD WILDLIFE TRUST

APPLICATION FORM, Part 1 of 2

Post title: /
Membership Fundraising Officer
Post reference: /
MFO715
/ Applicant’s reference no (For HR to complete):

Part 1 – personal details (essential), equal opportunities monitoring (optional).

Please complete:

1. Personal Details

Surname: / First Name:
Address: / Tel Nos:
Home:
Daytime:
Mobile:
Postcode: / E-mail:

Where did you see this post advertised?

2. Equal Opportunities and Monitoring

Please note that it is not compulsory to complete the Equal Opportunities and Monitoring section of this form. The information requested will be used for monitoring and administration purposes only, and is not seen by the recruitment panel. Part B only is given to the recruitment panel for short-listing. This is done to reduce the possibility of unfair and unlawful discrimination.

1. Gender

Male

/

Female

2. Age
16 - 18 / 19 - 24 / 25 - 30 / 31 - 40 / 41 - 50 / 51 - 60 / 61+
3. Ethnic Group
White / Black African / Black Caribbean
Mixed: Black & White / Mixed: Asian & White / Chinese
Asian: Bangladeshi / Asian: Indian / Asian: Pakistan
Other / Please specify:
4. Religious Belief
None / Church of England / Protestant
Roman Catholic / Buddhist / Hindu
Jewish / Muslim / Sikh
Other / Please specify:

5. Disability

The Equality Act 2010 defines a disabled person as someone who has a physical or mental impairment that has a substantial and long term adverse effect on their ability to perform normal day to day activities. It also covers people who have been diagnosed with HIV, cancer or multiple sclerosis.

'Substantial' means more than minor or trivial, eg it takes much longer than it usually would to complete a daily task like getting dressed. 'Long-term' means that the effect of the impairment has lasted or is likely to last for at least twelve months.'Normal day-to-day activities' include everyday things like eating, washing, walking and going shopping.

Does this definition apply to you?

Yes
No
Prefer not to say

If you prefer please put this document in a sealed envelope marked:

Private & Confidential

FAO Human Resources

I confirm that all of the information given in this form is correct and complete.

Signed: Date:

Protecting Wildlife for the Future