Durham City Homes - Diversity monitoring Form
Durham City Homes is an inclusive employer and considers suitably experienced
and qualified applicants regardless of personal characteristics such as disability, sex,
religion/belief, sexual orientation, relationship status, ethnicity or age.
The information you provide will be treated as strictly confidential and anonymised.
It will be used solely for statistical analysis. You are not obliged to answer these
questions, however this information will enable the company to monitor and
develop services provided to our staff and customers.
Post title:
What is your sex?
Please tick the
appropriate box:
Male
What age
bracket are you
within?
Please tick the
appropriate box:
16 – 24
years
□
45 – 54 years
□
25 – 34
years
□
55 – 64 years
□
35 – 44
years
□
65+ years
□
□
□
Female
Do you consider Yes
No
yourself to be a
disabled person? If you answered yes, which of the following describes your
disability best?
□
Learning disability
Blind
Visually impaired
Wheelchair user
Other physical
impairment
(please state)
□
□
□
□
□
□
Deaf
Hearing impaired
Mental health issues
Speech impairment
A medical condition
(please state)
□
□
□
□
□
What is your
sexual
orientation?
Please tick the
appropriate box:
Heterosexual
Lesbian
What is your
ethnicity?
White
Please tick the
appropriate box:
Welsh
English
Scottish
□
Gay
□
Bisexual
□
□
□
□
Northern Irish
□
□
□
□
British
Irish
Any other white
background (please
state)
Traveller
Gypsy / Roma
Traveller of Irish
Descent
Other member of
the travelling
community
□
Black
□
□
□
Asian
Black or Black British
Caribbean
African
□
□
□
Mixed
Asian or Asian
British
□
White and Black
Caribbean
□
Indian
□
□
□
White and Black African
□
□
□
Pakistani
Bangladeshi
Chinese
Any other Asian
background
(please state)
□
□
White and Asian Any
other mixed background
(please state)
Any other ethnic group
(please state)
□
How would you
describe your
religion?
Muslim
I am not religious
□
□
□
□
Other (please state)
□
□
□
□
Yes
□
No
□
□
A disabled Child under 18
years of age
□
□
Another vulnerable
person
□
Christian
Hindu
Jewish
Are you the
primary carer for
someone?
Sikh
Buddhist
If yes, do you care for?
A child under 18
years of age
A disabled adult
Durham City Homes Job Application Form
Application for the post
of:
Reference number:
Title (Mr/Mrs/Miss/Other):
Forename(s):
Surname:
Home address:
Postcode:
Home telephone number:
Mobile number:
Email address:
Do you have a current
driving licence?
If this post is open to job
share, do you wish to
apply for this post in a job
share capacity?
Yes
No
Yes
No
Provisional
Disabled candidates.
Disability The Equality Act 2010 defines a disabled person with: ‘A physical or mental
impairment, which has substantial and long term adverse effect on his/her ability to
carry out normal day to day activities’.
Do you consider yourself
to have a disability?
Please tick the
appropriate box:
Do you have any specific
arrangements or have
any additional
requirements that you
wish us to know about to
enable you to attend for
interview?
Yes
No
Yes
No
Please give details if applicable:
Legal Information
Under the terms of the Asylum and Immigration Act 1996, Durham City Homes
Limited can only employ people who are entitled to work in the UK.
Durham City Homes Limited will need to have sight of an original document that
confirms this entitlement. It would also be helpful if you could confirm this
entitlement at this stage.
I confirm that I am entitled to work in the UK.
Yes
No
Declaration
I declare that the information on this application form is full, accurate and
complete and I understand that if I provide false information or fail to provide full,
complete and accurate information, this may lead to the decision that my
application cannot be considered any further, the withdrawal of offer of
appointment, or by my dismissal, without notice, if I have been appointed.
I also understand that canvassing of members or employees of the company
whether directly or indirectly, will result in this application being disqualified.
Signature:
Print name:
Date:
Data protection
The personal information supplied by you on this application form will be used only
to consider your application for employment with this company.
The information you supply on the Equal Opportunities Form will be used for those
purposes stated only and will be retained in an anonymised form so that it cannot
be linked to individual applicants.
The information you supply will be retained only as long as necessary for the
purposes of recruitment and monitoring.
Checks will be undertaken to verify information provided by applicants in their
application, for example by taking up references and if appropriate, checking
qualifications with educational institutions or other appropriate agencies.
All offers of employment will be subject to the appropriate pre-employment checks.
Current Employment
Please provide details of your current or most recent employment. If currently
unemployed please give your most recent post with date of finish and reasons for
this.
Name and address of
employer:
Job title:
Salary:
Duration (month and
year):
Notice period:
Brief description of
responsibilities and duties:
Previous Employment History
Please provide full details of all previous posts you have held, starting with the most
recent first. You will also need to include any dates (if applicable) when you have
not been in employment.
Duration (month
Employer name
Job role
Reason for leaving
and year)
Education and Qualifications
Please provide details of your education and qualifications including any ongoing
course/qualifications. N.B appointment will only be confirmed subject to receipt of
official certificates in support of below.
Date
School/College attended
Type of
qualification and
subject
Level achieved
Relevant Courses and Professional Bodies
Please provide details of any valid non-qualification courses, internal training and
further training (including details of membership of any professional body)
Person Specification
Please use this section to demonstrate that you have the essential and where
possible desirable experience, skills and knowledge as stated on the person
specification of the post for which you are applying. Candidates who do not
evidence that they meet the essential qualifications and experience listed on the
person specification will not be shortlisted.
Durham City Homes Values
In no more than 250 words for each section, please provide examples of what each
value means for you and why do you think it is important to Durham City Homes.
People first: People are at the heart of
everything we do. In our communities
the way we listen and respond to people
will determine the way we grow. It is only
by connecting with and trusting people
that living can be fully brought to life.
Outstanding delivery: Push the
boundaries of customer service and
added value through proactive
behaviour. Because the smallest detail
can make the biggest difference,
outstanding must be the new standard
and the new routine.
Proud communities: Taking responsibility
and feeling confident only occurs when
there is a sense of pride and optimism at
home. Positive steps lead to more
positive steps and as a result, there is an
ability to create and seize better
opportunities
References
Please give the details of two independent referees from whom the company will
seek information regarding your suitability for this job. One of the referees must be
your current or most recent employer. Next of kin or immediate relatives should not
be named as referees.
Name:
Name:
Occupation:
Occupation:
Organisation:
Organisation:
Address:
Address:
Postcode:
Postcode:
Tel:
Tel:
Email:
Email:
Can we contact prior to interview?
Can we contact prior to interview?
Yes
Yes
No
No
Thank you for completing this form.
Please return a completed copy by email to [email protected]