CVs

First Name *

Last Name *

Email Address *

House Number *

Street name *

City *

Post Code *

Phone Number *

Sensitive Personal Data

Equality and Diversity Monitoring Form

DepaxCare wants to meet the aims and commitments set out in its Equality and Diversity Policy. This
includes, not discriminating under the Equality Act 2010, and building an accurate picture of the
make-up of the workforce in encouraging equality and diversity.
We need your help and co-operation to enable us to do this, but filling in this form is voluntary.
The information you provide will stay confidential and will be stored securely and limited to only
authorised staff in our team.

Gender *

Male

Female

Non-Binary

Prefer not to say

Are you married or in a civil partnership? *

Yes

No

Prefer not to say

Age *

What is your Ethnicity?

Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you
perceive you belong. Please tick the appropriate box.

White

Mixed/multiple ethnic groups

Asian/Asian British

Black/ African/ Caribbean/ Black British

African

Caribbean

Prefer not to say

Other ethnic group

Arab	Prefer not to say

Do you consider yourself to have a disability or health condition? *

Yes	No
Prefer not to say

What is the effect or impact of your disability or health condition on your ability to give your best at work? Please write here: (If you consider yourself without a disability please write 'not applicable' ) *

The information in this form is for monitoring purposes only. If you believe you need a ‘reasonable
adjustment’, then please discuss this with your manager, or the manager running the recruitment
process if you are a job applicant.

What is your sexual orientation? *

What is your religion or belief? *

Do you suffer from or have you ever had any health condition as listed below? * 🛈

Please provide your bank account details, National Insurance number , Date of birth and Passport number. *

Please upload your Passport, Recent utility bill, Residence permit and Proof of National Insurance number ( NI) *

Please upload a copy of your CV

Sign *

clear