Personal Details

Application for the post of:

Name:

Date of Birth:

Address:

Postcode:

Home telephone number:

Mobile:

Email address:

Are you related to a member of staff or Board Member: Yes/No

If yes, what is their name & position in the organisation:

If yes, what is your relationship:

Please answer the following only if a DBS check is required for this post. Do you have any convictions, cautions, reprimands or warnings current, spent or pending for any offences?

Yes/No

If yes, please give details of the convictions including dates, nature of offences and details of sentences.

I declare that the information given on this form is true and complete to the best of my knowledge and that I give my consent for any of my previous employers to be contacted and for information to be obtained from the police.

SIGNATURE

DATE

Equality and Diversity questionnaire - Strictly Confidential

1.  ETHNIC GROUP:

White

¨  Welsh / English / Scottish / Northern Irish / British

¨  Irish

¨  Gypsy or Irish Traveller

¨  Any other, please specify ______

Mixed / multiple ethnic groups

¨  White and Black Caribbean

¨  White and Black African

¨  White and Asian

¨  Any other, please specify______

Asian / Asian British

¨  Indian

¨  Pakistani

¨  Bangladeshi

¨  Chinese

¨  Any other, please Specify______

Black / African / Caribbean / Black British

¨  African

¨  Caribbean

¨  Any other, please specify______

Other ethnic group

¨  Arab

¨  Any other, please specify ______

¨  Not declared

2. LANGUAGES

Are you a Welsh speaker? Yes/No

Do you speak any other languages? Yes/No

If yes, please state______

3. DISABILITY

Do you consider yourself to have a disability? Yes/No

If yes, please provide details of your disability and any specific adjustment required to accommodate your needs.

4. GENDER

Female Male Transgender

5. AGE

Under 25 25 – 34 35 – 44 45 – 54 55 - 65 Over 65

6. MARITAL STATUS

Co-habiting Married Same sex civil partnership Single

7. RELIGION OR BELIEF

Anglican Buddhist Catholic Hindu Jewish Muslim

Rastafarian Other Christian Sikh None

Other Religion/Belief, please specify______

8. SEXUAL ORIENTATION

Lesbian Gay Bisexual Heterosexual Other