Durham City Homes - Diversity Monitoring Form

Durham City Homes - Diversity Monitoring Form

Durham City Homes - Diversity monitoring Form

Durham City Homes is an inclusive employer and considers suitably experienced and qualified applicants regardless of personal characteristics such as disability, sex, religion/belief, sexual orientation, relationship status, ethnicity or age.

The information you provide will be treated as strictly confidential and anonymised. It will be used solely for statistical analysis. You are not obliged to answer these questions, however this information will enable the company to monitor and develop services provided to our staff and customers.

Post title:
What is your sex? Please tick the appropriate box: / Male / □
Female / □
What age bracket are you within?
Please tick the appropriate box: / 16 – 24 years / □ / 45 – 54 years / □
25 – 34 years / □ / 55 – 64 years / □
35 – 44 years / □ / 65+ years / □
Do you consider yourself to be a disabled person? / Yes / □ / No / □
If you answered yes, which of the following describes your disability best?
Learning disability / □ / Deaf / □
Blind / □ / Hearing impaired / □
Visually impaired / □ / Mental health issues / □
Wheelchair user / □ / Speech impairment / □
Other physical impairment
(please state) / □ / A medical condition
(please state) / □
What is your sexual orientation? Please tick the appropriate box: / Heterosexual / □ / Gay / □
Lesbian / □ / Bisexual / □
What is your ethnicity?
Please tick the appropriate box: / White
English / □ / Northern Irish / □
Welsh / □ / British / □
Scottish / □ / Irish / □
Any other white background (please state) / □
Traveller / Black
Gypsy / Roma / □ / Black or Black British / □
Traveller of Irish Descent / □ / Caribbean / □
Other member of the travelling community / □ / African / □
Asian / Mixed
Asian or Asian British / □ / White and Black Caribbean / □
Indian / □ / White and Black African / □
Pakistani / □ / White and Asian Any / □
Bangladeshi / □ / other mixed background (please state) / □
Chinese / □
Any other Asian background (please state) / □ / Any other ethnic group (please state) / □
How would you describe your religion? / Christian / □ / Muslim / □
Hindu / □ / Sikh / □
Jewish / □ / Buddhist / □
I am not religious / □ / Other (please state) / □
Are you the primary carer for someone? / Yes / □ / No / □
If yes, do you care for?
A child under 18 years of age / □ / A disabled Child under 18 years of age / □
A disabled adult / □ / Another vulnerable person / □
Durham City HomesJob Application Form
Application for the post of:
Reference number:
Title (Mr/Mrs/Miss/Other):
Home address:
Home telephone number:
Mobile number:
Email address:
Do you have a current driving licence? / Yes No Provisional
If this post is open to job share, do you wish to apply for this post in a job share capacity? / Yes No
Disabled candidates.
Disability The Equality Act 2010 defines a disabled person with: ‘A physical or mental impairment, which has substantial and long term adverse effect on his/her ability to carry out normal day to day activities’.
Do you consider yourself to have a disability?
Please tick the appropriate box: / Yes No
Do you have any specific arrangements or have any additional requirements that you wish us to know about to enable you to attend for interview? / Yes No
Please give details if applicable:
Legal Information
Under the terms of the Asylum and Immigration Act 1996, Durham City Homes Limited can only employ people who are entitled to work in the UK.
Durham City Homes Limited will need to have sight of an original document that confirms this entitlement. It would also be helpful if you could confirm this entitlement at this stage.
I confirm that I am entitled to work in the UK.
Yes No
I declare that the information on this application form is full, accurate and complete and I understand that if I provide false information or fail to provide full, complete and accurate information, this may lead to the decision that my application cannot be considered any further, the withdrawal of offer of appointment, or by my dismissal, without notice, if I have been appointed.
I also understand that canvassing of members or employees of the company whether directly or indirectly, will result in this application being disqualified.
Print name:
Data protection
The personal information supplied by you on this application form will be used only to consider your application for employment with this company.
The information you supply on the Equal Opportunities Form will be used for those purposes stated only and will be retained in an anonymised form so that it cannot be linked to individual applicants.
The information you supply will be retained only as long as necessary for the purposes of recruitment and monitoring.
Checks will be undertaken to verify information provided by applicants in their application, for example by taking up references and if appropriate, checking qualifications with educational institutions or other appropriate agencies.
All offers of employment will be subject to the appropriate pre-employment checks.
Current Employment
Please provide details of your current or most recent employment. If currently unemployed please give your most recent post with date of finish and reasons for this.
Name and address of employer:
Job title:
Duration (month and year):
Notice period:
Brief description of responsibilities and duties:
Previous Employment History
Please provide full details of all previous posts you have held, starting with the most recent first. You will also need to include any dates (if applicable) when you have not been in employment.
Duration (month and year) / Employer name / Job role / Reason for leaving
Education and Qualifications
Please provide details of your education and qualifications including any ongoing course/qualifications. N.B appointment will only be confirmed subject to receipt of official certificates in support of below.
Date / School/College attended /
Type of qualification and subject / Level achieved
Relevant Courses and Professional Bodies
Please provide details of any valid non-qualification courses, internal training and further training (including details of membership of any professional body)
Person Specification
Please use this section to demonstrate that you have the essential and where possible desirable experience, skills and knowledge as stated on the person specification of the post for which you are applying. Candidates who do not evidence that they meet the essential qualifications and experience listed on the person specification will not be shortlisted.
Durham City Homes Values
In no more than 250 words for each section, please provide examples of what each value means for you and why do you think it is important to Durham City Homes.
People first: People are at the heart of everything we do. In our communities the way we listen and respond to people will determine the way we grow. It is only by connecting with and trusting people that living can be fully brought to life.
Outstanding delivery: Push the boundaries of customer service and added value through proactive behaviour. Because the smallest detail can make the biggest difference, outstanding must be the new standard and the new routine.
Proud communities: Taking responsibility and feeling confident only occurs when there is a sense of pride and optimism at home. Positive steps lead to more positive steps and as a result, there is an ability to create and seize better opportunities
Please give the details of two independent referees from whom the company will seek information regarding your suitability for this job. One of the referees must be your current or most recent employer. Next of kin or immediate relatives should not be named as referees.
Can we contact prior to interview?
Yes No / Name:
Can we contact prior to interview?
Yes No

Thank you for completing this form.

Please return a completed copy by email to