Role Ref No:
Candidate No:
We’re all unique,
that’s
what makes us
GREAT.
Monitoring information
We would be grateful if you could complete the following information. The information in this section will be
detached and will not be seen by the recruiting officers. The information will remain confidential and will be
used to provide an overall profile analysis of candidates applying for non-executive positions and to monitor
equal opportunities.
A. Date of birth ……………………………………………………
B. Disability
The Equality Act 2010 protects disabled people. The Equality Act 2010 defines a person as disabled if they
have a physical or mental impairment, which is substantial and long-term (i.e. has lasted or is expected to last
at least 12 months) and has an adverse effect on the person’s ability to carry out normal day-to-day activities.
Do you consider yourself to have a disability according to the terms given in the Equality Act?
Yes
No
If you need any adjustments to be made to enable to you attend an interview or to participate in the selection
process we will make adjustments for you, you don’t have to tell us now.
If your application is successful and you are invited for interview, we will write to you advising you of the date
and time of the interview. We will also inform you if there are any other selection processes that you will be
required to undertake. In this letter we will also ask you if you require any adjustments to be put in place to
support you during the selection process.
Role Ref No:
C. Ethnic Group
Asian
Bangladeshi
Indian
Pakistani
Any other Asian background (specify below)
Black
African
Caribbean
European
Any other Black background (specify below)
Chinese
Chinese
Any other Ethnic background (specify below)
Mixed
White and Asian
White and Black African
White and Black Caribbean
White and Chinese
Any other Mixed background (specify below)
White
British
Irish
Any other White background (specify below)
Gypsy or Traveller
Irish
Romany
Any other
Any other ethnicity or nationality not listed please state
Eastern European
Candidate No:
Role Ref No:
Candidate No:
D. Gender
Male
Female
Have you ever identified as transgender?
For the purpose of this question ‘transgender’ is defined as an individual who lives, or wants to live, full-time in the
gender opposite to that which was recorded at birth.
Yes
No
Prefer not to say
E. Religion or belief
Which group below do you most identify with?
No religion
Baha’i
Buddhist
Christian
Hindu
Jain
Jewish
Muslim
Sikh
Prefer not to say
Any other religion or belief (specify below)
F. Marital Status
Married
Separated
Single
Divorced
Civil Partnership
Prefer not to say
G. Sexual orientation
Bisexual
Gay man
Prefer not to say
Gay woman/Lesbian
Heterosexual/Straight
Other
Widowed
Role Ref No:
Candidate No:
Criminal convictions
Have you ever been convicted of a criminal offence or are you at present the subject of any criminal charges?
Yes
No
If yes, please give details:
Please note that convictions regarded as ‘spent’ under the terms of the Rehabilitation of Offenders Act 1974 need not
be disclosed. However, some positions within New Charter Housing Trust Group may be exempt from the Act. This
means if you apply for a post that is exempt from the Act you should disclose these criminal offences.
We would like to thank you for completing this form.
Accessible formats:
If you have any specific requirements to enable you to complete the application process please contact the
Human Resources team on 0161 331 2000. We can provide vacancy details in a range of accessible formats.