BARCA-Leeds Is Committed to Promoting Equality of Opportunity and Diversity in All Aspects

(Office use only) Application Reference No ______

Better Leeds Communities is committed to promoting equality of opportunity and diversity in all aspects of business life. Successful applicants will be chosen on merit and abilities only and will not receive less favourable treatment on the grounds of age, ethnic origin, gender, disability, marriage and civil partnership, religion/belief, sexual orientation, gender reassignment or pregnancy and maternity (exception may be valid where there is a Genuine Occupational Reason (GOR)).
This part of the application form will be detached by a member of the HR team and not seen by the recruiting panel or used in the recruitment process. The information provided will however be recorded to ensure that the business is reaching out to a wide range of potential applicants and monitored to check that minority groups are not being treated less favourably.
Please read the statement below. Completion of this form implies your understanding and consent.
I understand that the details provided on this form will be recorded and stored within the provisions of the Data Protection Act 1998 and may be shared with third parties, eg Government Bodies, etc.
Name / ______/ Date of Birth / ______/ Age / ______
Gender / Female / Male / Transsexual / Prefer not to say
Marital Status / Civil Partnership / Civil Widowed / Divorced
Dissolved / Married / Single
Separated / Widowed / Prefer not to say
Ethnic Origin
Asian or Asian British / Bangladeshi / Indian / Pakistani / Other Asian background
Black or Black British / African / Caribbean / Any other Black background
Chinese / Chinese
Mixed / White and Asian / White and Black African
White and Black Caribbean / Any other mixed background
White / English / Irish / Northern Irish
Scottish / Welsh / European
Other / Any Other Ethnic Group / Prefer not to say
Sexual Orientation / Bisexual / Gay man / Heterosexual / straight
Lesbian / gay woman / Other / Prefer not to say
Religion / Buddhist / Christian / Hindu / Jewish
Muslim / Sikh / Agnostic / Athiest
No religion / Other / Prefer not to say
Disability
The Disability Discrimination Act (DDA) defines a disability as a condition, either physical or mental, which is substantial and has a long-term effect.
Do you consider yourself to have a disability? YES / NO
If you have answered Yes, please indicate the type of impairment which applies to you. If you experience more than one type of impairment, please tick all the types that apply. If it does not fit any of these, please tick ‘Other’ and specify.
Please tick appropriate box
Physical/mobility impairment, such as difficulty using your arms or mobility issues which require you to use a wheelchair or crutches
Visual impairment, such as being blind or having a serious visual impairment
Hearing impairment, such as being deaf or having a serious hearing impairment
Mental health condition, such as depression or schizophrenia
Learning disability/difficulty such as Down’s Syndrome or dyslexia or a cognitive impairment such as autistic spectrum disorder
Long standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease or epilepsy
Other (please specificy)
Prefer not to say
Please give any other information that you would like to
Signed ………………………………………………………. Date ………………………………………………………

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