KTCC Monitoring Form

KTCC Monitoring Form

In order to fulfill our commitment to Equal Opportunities and diversity in the community, we would be grateful if you could please complete our monitoring form below. This information is kept in strict confidence, and does not inform any decisions made regarding a position at KTCC.

Gender / Female Male Prefer not to disclose
Do you consider yourself to have a disability / Disability is defined as “physical or mental impairment, which has a substantial and long term adverse effect on a person’s ability to carry out normal day to day activities”
Yes No Prefer not to disclose
What is your ethnic group? / Asian / Asian British Black / African / Caribbean / Black British
Bangladeshi African
ChineseCaribbean
Indian Any other Black/Caribbean background:
Pakistani ______
Any other Asian background:
______
Mixed / Multiple Ethnic Groups White
White and Asian British / English /Welsh/
White and Black African Scottish / Northern Irish
White and Black Caribbean Gipsy or Irish Traveller
Any other Mixed background:
______
Other Ethnic Group: ______Prefer not to disclose
Which of these best describes your sexual orientation: / BisexualHeterosexual / straight
Gay / LesbianPrefer not to disclose
Which religious group, if any, do you most identify with? / Athiest Sikh
Christian (CofE, Catholic, Protestant) Muslim
Hindu Other religion or belief:______
Jewish Prefer not to disclose
Are you a carer? / A carer is a person who is unpaid and looks after or supports someone else who needs help with their day-to-day life because of their age, a long-term illness, disability, mental health problems or substance misuse ().
Yes No Prefer not to disclose
Are you currently in receipt of benefits? / Yes No Prefer not to disclose
Do you have any unspent criminal convictions? / As this post involves working directly with young people, the provisions of the Rehabilitation of Offenders Act do not apply. This means that you are not entitled to withhold information about convictions which, for other purposes are ‘spent’ under the provision of the act. Failure to disclose such convictions could result in your dismissal later. Information will be treated as confidential and will be considered only in relation to applications for positions to which the order applies.
Yes No
Where did you hear about this opportunity?
‘I declare all above information to be true at the time of writing, and I understand that any misleading information may lead to instant dismissal’.
Signed:
Date: