Personal Information & Emergency Contact Form

Personal Information & Emergency Contact Form


PERSONAL INFORMATION & EMERGENCY CONTACT FORM

PLEASE RETURN THIS FORM TO HUMAN RESOURCES, MUNICIPAL BUILDINGS. PLEASE COMPLETE BOTH SIDES OF THIS FORM.
At Inverclyde Council we are committed to ensuring that fair practices are adhered to throughout the course of your employment with us. Our equal opportunities policy aims to ensure that no one is treated less favourably on any grounds including: gender or gender identity; race; colour; nationality; ethnic or national origins; religion or belief; marital or civil partnership status; disability; sexuality or sexual orientation; or age. Without accurate data on the composition of our workforce we are unable to monitor the effectiveness of our equal opportunities policy and identify and address potential discriminatory practices. To help us do this, we ask you to complete this personal information form and return it with your contract of employment. The information you provide will be treated in the strictest confidence and will be used for monitoring and statistical purposes only. If you would like to talk to someone in confidence before completing this form, you can contact HR on 01475 712740 and ask to speak to an HR Advisor. This form is available, on request, in large print, Braille, on audiotape, or computer disc.
POST APPLIED FOR: / ADVERT REF:
SERVICE:
1. PERSONAL DETAILS
Name: / Date of Birth:
Address: / Home Telephone:
Mobile:
NI Number: / Email Address:
2. GENDER IDENTITY
How would you describe your gender?
Female Male Prefer not to answer
Have you ever been identified as a transgender person or trans person?
Yes No Prefer not to answer
3. SEXUAL ORIENTATION
Bisexual Gay Heterosexual/Straight Lesbian Other Prefer not to answer
4. MARITAL STATUS
Divorced Living with Partner Married/Civil Partnership Separated
Widowed Single Prefer not to answer
5. DISABILITY
Under the terms of the Equality Act 2010, a disability is defined as 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 tasks. If you consider yourself to be disabled, please tick 
Yes No Prefer not to answer
If yes to the above question, please state the type of impairment which applies to you. You may indicate more than one. If none of the categories apply, please mark ‘Other’ and specify the type of impairment.
Learning disability Physical Impairment
Long standing illness Sensory Impairment - Visual
Mental health condition Sensory Impairment - Hearing
Prefer not to say Other, please specify ______
6. CARING RESPONSIBILITIES
Do you have caring responsibilities?
Yes (children under 18) Yes, other No Prefer not to answer
7. NATIONAL IDENTITY
What is your national identity?
Scottish Northern Irish English British
Welsh Prefer not to say Other - Please specify ______
8. ETHNIC GROUP
What is your ethnic group? For this question, you should choose one section from A to F to indicate your ethnic group. Choose G if you prefer to not answer this question or list your ethnic group if not listed in A to F.
A. White
Scottish
Other British
Irish
Gypsy/Traveller
Polish
Eastern European (e.g. Polish)
Other white ethnic group
B. Mixed or Multiple Ethnic Groups
Any mixed or multiple ethnic groups
C. Asian, Asian Scottish or Asian British
Pakistani, Pakistani Scottish or Pakistani British
Indian, Indian Scottish or Indian British
Bangladeshi, Bangladeshi Scottish or Bangladeshi British
Chinese, Chinese Scottish or Chinese British
Other /
D. African
African, African Scottish or African British
Other
E. Caribbean or Black
Caribbean, Caribbean Scottish or Caribbean British
Black, Black Scottish or Black British
Other
F. Other Ethnic Group
Arab, Arab Scottish or Arab British
Other
G. Prefer not to answer / Other Ethic Group
Prefer not to answer
Other ethnic group, Please specify______
9. RELIGION OR BELIEF
Buddhist Church of Scotland Hindu Jewish Muslim Sikh Roman Catholic
Other Christian Prefer not to Answer None
Other Religion or Belief, please specify ______
10.VOLUNTEER / REGULAR RESERVIST OR FORMER ARMED SERVICES
Please state if you were a Volunteer/ Regular Reservist or Former Armed Services ______
______
Which force (Army/Navy/RAF)? ______
11. MEMBER OF A TRADE UNION
Yes No Prefer not to answer
If Yes, please state which Union______
12. EMERGENCY CONTACT & NEXT OF KIN
Emergency Contact Name:
Relationship to You:
Emergency Contact Address:
(Include Postcode)
Emergency Contact Home Tel:
Emergency Contact Work Tel:
Emergency Contact Mobile:
Emergency Contact E-mail address:
Next of Kin Name (if different):
Next of Kin Contact Telephone Number:
Should any of the aforementioned details change, it is your responsibility to notify Human
Resources as soon as possible.
Signed: / ______ / Date: / ______

Data Protection: Inverclyde Council is obliged to comply with current Data Protection Laws and will use this information for the purposes of processing your personal information for the performance of a contract with you and related purposes.

Further information can be found at www.inverclyde.gov.uk/privacy

PERS/REC20