Passion Home Care | Equal Opportunities Form

Which position are you applying for?*

Job Reference Number if Applicable

Closing Date for the Position

Data Protection Consent Statement

In submitting the information via the website you are agreeing to us holding your information for the purpose of applying for a job at Passion Home Care or are requesting your details to be held on file should a suitable position become available. Data submitted via the website will be held for 12 - 24 months in our email accounts and on our back office systems. Data held on the website will be deleted within 12-months. If you require more information on our Data Protection Policy and Data Retention Policy prior to submitting any details please use the contact form. If you do not want us to hold your information on our systems please telephone us to discuss.

Data Protection Consent*

Yes - You agree to the data submitted via the form kept on our systems for up to 24-months.

No - Please delete it immediately.

PERSONAL DETAILS AND CONTACT

The following section should be completed. All fields are mandatory.

Name*

Address*

Email*

EQUAL OPPORTUNITIES

Please complete the following form.

Introduction and Aims

The information supplied on this form will be used in total confidence and in accordance with current Data Protection Legislation. It will help to ensure that the service properly monitors and conforms with its policies relating to the equality of opportunity.

Information will be used for monitoring and for no other purpose.

Our committed aim is to allow our support staff to develop their skills and realise their maximum potential as individuals without any wish on the part of the service to limit their opportunities.

Gender*

Male

Female

Prefer Not to Say

Are you married or in a civil partnership?*

Yes

No

Prefer not to Say

Age*

What is your Ethnicity/Origin?

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 boxes:

White

Mixed / Multiple Ethnic Groups

Asian / Asian British

Black/ African/ Caribbean/ Black British

African

Caribbean

Prefer not to say

Other, please specify:

Other

WORK, HEALTH, SEXUAL ORIENTATION

The following questions are based on your work, health and Sexual Orientation.

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 in:

Reasonable Adjustments

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 you sexual orientation?

Religious beliefs?

What is your current employment status?

What is your flexible working arrangements?

Do you have caring responsibilities? If yes, please tick all that apply

None

Primary carer of a child/children (under 18)

Primary carer of disabled child/children

Primary carer of disabled adult (18 and over)

Primary carer of older person

Secondary carer (another person carries out the main caring role)

Prefer not to say

Electronic Signature Confirmation

I can confirm that to the best of my knowledge the above information is correct. I accept that providing deliberately false information could result in my dismissal.

Electronic Signature*

Date of Electronic Signature*

Data Consent

In ticking the following box and submitting the data completed in the above form you agree to us processing the information as stated at the start of the form. You will need to tick the box prior to submission.

Data Consent*

Data Consent

Instructions

When submitting this form it will generate an email to Passion Home Care. The information completed is the second part of the application process and on the successful submission you will be redirected to the ID Verification Form. When completing this form please use the same email address as used as part of this submission. We will not process an application until we have received the "Job Application", "Health Questionnaire", "Equal Opportunities", "ID Verification Form" and the "Rehabilitation of Offenders Declaration".

Disclaimer

Passion Home Care will not accept a partially complete application and if any of the forms are missing we can not guarantee your application will be considered. For each form you will receive a confirmation email confirming the submission and we recommend that you retain this as proof. On submission you will be redirected to the next form but you do not need to complete within a specified time as long as all are received prior to the closing data of the advertised position.