The Diocese of Sheffield
Additional Information – Strictly Confidential
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This information will only be seen by members of staff administrating this vacancy.
Position applied for:Surname (CAPITALS): /
Title:
Other names in full (CAPITALS):
Disclosure of convictions(s)
Applications from ex-offenders are welcomed and will be considered on their merit. Convictions that are irrelevant to this job will not be taken into account.
You are required to disclose any convictions which are not ‘spent’ by virtue of the Rehabilitation of Offenders Act 1974. Please note that for legal and accounting professions, you are required to disclose all convictions, including those that are ‘spent’ by virtue of the Rehabilitation of Offenders Act 1974.
Have you been convicted of a criminal offence that is not spent? If yes, please give details of date(s), offence(s) and sentence(s) passed (please continue on a separate sheet if necessary).
Dates / Offence / Sentence
Diocese of Sheffield
EQUAL OPPORTUNITIES MONITORING FORM
The Diocese of Sheffield supports the principle of equal opportunities in employment and opposes all forms of unlawful and unfair discrimination. Our aim is to ensure that job applicants and employees are treated equally and fairly and are recruited, selected, trained and promoted on the basis of job requirements, skills, abilities and other objective and job related criteria. We will also ensure that individuals are not disadvantaged by conditions or requirements which cannot be shown to be justified as being necessary for the safe and effective performance of the job. To assist with this aim and to comply with legislation, we would ask that you please complete and return this form. The information provided will be used solely for monitoring purposes and will not be available to those involved in the selection process.
Name:
Position applied for: Date:
Please ensure that you read all the categories and then place a cross in the box that applies to you.
Ethnic Origin
White
o British
o Scottish
o Welsh
o Irish
o English
o Any other White background: Please state
Mixed Heritage
o White & Black Caribbean
o White & Black African
o White & Asian
o Any other Mixed background: Please state
Asian or Asian British
o Indian
o Bangladeshi
o Pakistani
o Any other Asian Background : Please state
Black or Black British
o Caribbean
o African
o Any other Black background : Please state
Chinese or other ethnic group
o Chinese
o Any other ethnic group: Please state
Disability
The definition of disability as outlined in the Equality Act 2010 is as follows:
“A 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”.
Under this definition, do you consider yourself to be disabled? Yes/No
Gender
Would you describe yourself as:
o Male
o Female
o Prefer not to say
Age Equality
Please mark the relevant box that currently reflects your age status:
o 18 or under
o 19 to 30
o 31 to 50
o 51 to 65
o Over 65
o Prefer not to say
Faith / Religion / Belief
Please mark the relevant box that best describes your current status
o Christian
o Buddhist
o Hindu
o Jewish
o Muslim
o Sikh
o None
o Other: Please specify:
o Prefer not to say
Thank you for your co-operation
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