Fullname: Gender: Male Female

EQUALOPPORTUNITIESMONITORING

Allapplicationsreceiveequaltreatmentregardless ofgender, race,ethnicornationalorigin,age,disability, religionorbelief, maritalstatusorsexualorientation.Theinformationyouprovidedoesnotformpartof theselectionprocess,willbetreatedinthestrictestconfidenceandusedformonitoringpurposesonly.

FullName: Gender: Male Female

Date of Birth: Age: Vacancy/Reference:

Please ENTER tick or Y (Yes) in only ONE box in each section (The options are listed alphabetically)

Section A
(A)British or Mixed British

(D) Scottish /
(B)English

(E) Welsh /
(C)Irish

(F) Or any other?

Specify if you wish
Section B
ASIAN
(A)Bangladeshi
(B)Indian
(C)Pakistani
(D)Or Any Other Asian Background

Specify if you wish / BLACK
(E)African
(F)Caribbean
(G)Or Any Other Asian Background

Specify if you wish
CHINESE
(H)Any Chinese Background

Specify if you wish / MIXED ETHNIC BACKGROUND
(H)Asian and White
(I)Black African and White
(J)Black Caribbean and White
(K)Or Any Other Mixed Ethnic Background

Specify if you wish
WHITE
(M)Any White Background

Specify if you wish / ANY OTHER ETHINIC BACKGROUND
(N)Any Other Ethnic Background

Specify if you wish
Section C

(L)Buddhist
(M)Christian
(N)Hindu
(O)Jewish / RELIGION

(P)Muslim
(Q)Sikh
(R)Other
(S)No Religion / Section C

(A)Bisexual
(B)Gay Man
(C)Gay Woman/
Lesbian
(D)Heterosexual/
Straight / SEXUAL ORIENTATION

(E)Other
(F)Prefer not to say

PLEASE TURN OVER

DISABILITY (GUARANTEED INTERVIEW SCHEME)

CCWater is committed to the employment of disabled people. To demonstrate our commitment we guarantee an interview to anyone with a disability whose application meets the minimum criteria for the post.

The Disability Discrimination Act 1995 defines disability as a physical or mental impairment, which has a substantial and adverse long-term effect on a person's ability to carry out normal day-to-day activities.

Do you consider that you have a disability as defined above? (For further information please refer to Information for

Applicants)

Yes No

Ifyouconsideryouhaveadisabilityandwishtoapplyforaguaranteedinterview,pleasecomplete thefollowing:

Name:
Arrangements(ifany)wecouldmake toassistyouifselectedforinterview
Ifullyunderstand thereasonforwhichthisinformationisbeingcollectedandIconsenttoprovideit
Signed:
Date: