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Office Use Only Applicant No. Post Number Post Name Closing Date
PERSONAL DETAILS (Please print if submitting hard copy. You are advised to complete all sections of this form) National Insurance Number: _________________ Date of Birth:______________ Title (Mr/Mrs/Ms/Miss/Dr etc.): _________ First names:__________________________ Last name____________________ Address: _________________________________________________________ ________________________________________________________________ ____________________________________ Post code:___________________ Telephone numbers: (daytime): _______________ (home/mobile)____________ Email: _______________________________________ Are you related to a Councillor or any employee of Gloucester City Council? (If so, please give details.)
REHABILITATION OF OFFENDERS ACT 1974 Have you any convictions that are not spent under the Rehabilitation of Offenders Act? (Please see information sheet.)
YES
NO
PREFERRED WORKING ARRANGEMENTS Full-time Annualised Hours Part-time Job share Term time only
Definitions of the above categories are given on the Flexible Working Arrangements information sheet INTERVIEW ARRANGEMENTS Do you need any arrangements made for the interview e.g. to accommodate disability. If so, please specify:
MONITORING INFORMATION Disability Do you consider you have a disability or impairment that needs to be taken into consideration in order to ensure that you have equal and fair access to employment?
Yes
No
Decline to identify
Male
Female
Ethnic Origin These are the categories used in the 2001 census. Choose a section and then indicate your category White Black or Black British Caribbean African Other BlackBackg round Asian or Asian British
Mixed
White & Black Caribbean White & Black AfricanWhite & Asian Other Mixed Background
The Council recognises that sexual orientation and religion or belief are very personal and sensitive issues. However, in order to determine equality in recruitment and selection and whether the Council has a representative workforce, we need to monitor these areas.
Sexual Orientation
Bisexual
Gay man
Religion or Belief
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
No religion
I declare that the information on this form is correct and that I agree to it being held and processed in accordance with the data protection Act 1998.
Signature:
Date:
(If completing this form electronically, in submitting this form you are agreeing that the information on this form is correct, and to it being held and processed in accordance with the data protection Act 1998.)