To Be Completed by Applicants

2-4 Middleton Crescent

Leeds, LS11 6JU

EQUAL OPPORTUNITIES MONITORING FORM

We are committed to employing a workforce that reflects the community we serve. In order to monitor our progress, we ask you to answer the questions below. If you do not wish to complete all or any part of this monitoring form, you do not have to do so.

(This form and your personal details on the application form will be separated from the rest of the application forms, and from each other, before information is recorded and before the application is used for shortlisting).

For the post of: ……………………………………………………

Please complete the section below. All the information will be treated as confidential, and will be used to assist us in improving our equal opportunities policies and practices.

Please complete the section below. All the information will be treated as confidential, and will be used to assist us in improving our equal opportunities policies and practices.

Please tick appropriate boxes.

1. Are you?

1. Which of the following do you feel applies to you?

5.Have you any disabilities (including mental health difficulties)?

(Circle as appropriate)Yes No

If yes, please describe: ______

6.Please indicate your age range: (circle as appropriate)

7.How did you learn of this vacancy?

Newspaper (please specify):……………………………………………………………..

Job Centre:………………………………………………………………………………….

Community Centre/Other Organisation (please specify):…..………………………….

Job Bulletin (please specify):…………………………………………………......

Specialised publication/journal (please specify):…….……………………………….....

Newsletter (please specify):……..…………………………………………………………

Word of mouth:…..………………………………………………………………………….

Internal:……………..………………………………………………………………………..

Other (please specify):……….……………………………………………………………..

Thank you for completing this form. Please return it with your application form, to the address above.