GREENSLEEVES HOMES TRUST – STRICTLY CONFIDENTIAL

EQUAL OPPORTUNITIES MONITORING

Greensleeves Careis committed to ensuring that no job applicant or employee receives less favourable treatment than others on the grounds of age, gender, marital status, race, ethnic or national origin, colour, nationality, disability, sexual orientation, gender re-assignment or religious beliefs or is disadvantaged by any conditions or requirements which cannot be shown to be justifiable.

POST APPLIED FOR:

NAME:
SITE APPLIED FOR:

Additional Personal Details

Applicants are requested to tick the relevant boxes below to enable Greensleeves Care to monitor its equal opportunity policy.The information collected allows us to determine the effectiveness of recruitment campaigns and helps to ensure our selection methods are fair and do not prejudice any single group.

Gender:

Male Female

Ethnic group:

Black-African Black-Caribbean Black-other (please specify)

______

Indian Pakistani Bangladeshi Asian Other (please specify)

______

Chinese White (UK) White (Irish)White (Other)(please specify)

______

Other (please specify)______

Age:

Date of Birth: ______

Disability Awareness:

Do you consider yourself to have a disability under the Disability Discrimination Act 1995?

YesNo

If Yes, please describe any adjustments that might need to be made either at interview or to the role itself:

Greensleeves Care is aware of and fully committed to its duty under the Equality Act to make reasonable adjustments in order to accommodate a successful applicant with a disability, either at interview or in employment.

Prior Links with Greensleeves Care:

Does your spouse or partner or any member of your family work for Greensleeves Care already? If so please state their name, the home in which they work and their job title:

Name / Home / Job Title

Greensleeves Care has a separate Policy on Personal Relations, a copy of which can be provided on request. Whilst the presence of a relevant personal relationship will not automatically bar an applicant from applying for work with the Greenleeves Care, there may be instances where a conflict of interest, or the need for a clear and unambiguous professional relationships, make an appointment untenable.

Recruitment of Ex-Offenders:

If you are applying for a post which is subject to a Disclosure & Barring Service (DBS), you should be aware that the disclosure of a previous offence or conviction will not automatically make you unsuitable for employment. In such circumstances, Greensleeves Care will carry out a full assessment of the disclosure, together with the role applied for. No decision, detrimental to your application will be made before an attempt to discuss the matter fully with you has been made. The actions of Greensleeves Care in this matter are based on the DBS Code of Practice, a copy of which is available on request.

Greensleeves Care will not unfairly discriminate against an individual who has a criminal record. To this end, a thorough explanation will be provided to all applicants whose application is in anyway affected by disclosures made. Greensleeves Care has a policy on DBS & POVA Checks and the Recruitment of Ex-Offenders, which is available on request.

Have you ever been convicted of a criminal offence or received any cautions?

(please notethat you should include offences considered to be spent under the Rehabilitation of Offenders Act 1974)

If “Yes”, please give details including the offence and dates:

DECLARATION

I can confirm that to the best of my knowledge the above information is correct. I accept that providing deliberately false information or deliberately failing to disclose information requested during the selection process could result in my dismissal.

Signature: Date:

THANK YOU FOR COMPLETING THIS FORM

Notice to Applicant:

This information is confidential and used for monitoring purposes and to ensure Greensleeves Care fulfils its duties under law. It will not be passed to or made available to the person responsible for short-listing or interview.

Where it is necessary to discuss any aspect of this form before appointment, (e.g. the nature of a disability)this may be done at the same time as the selection interview, but not as part of the selection interview.

Oncecompleted please return directly to:

The Home Manager

Queen Elizabeth House

38 Southborough Road

Bickley

Bromley

Kent BR1 2EE

Please note that this form will normally be retained securely by Greensleeves Careas follows:

1)For a period of 1 year following the end of the recruitment process where the application has not been successful.

2)For a period of 6 years following the termination of employment where the application is successful.

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