EQUAL OPPORTUNITIES
NAME:……………………….….….…POST APPLIED FOR:……………….….................. REF NO:…………….
PSS has a Dignity at Work Policy which aims to eliminate discrimination in employment. Staff are selected on merit only, therefore all applicants will be afforded equal opportunities in employment irrespective of any protected characteristics that they may have. We are committed to the monitoring of this policy to ensure that it works, but we need your help to do this.
Are you: Male Female (please tick) What is your religion:
Age Range – information required for monitoring purposes only.
16–20	21–25	26–30	31–35	36–40	41–45
46-50	51–55	56–60	61–65	66+
I would describe my ethnicity as follows: (please tick)
White Black or black British British Caribbean Irish African Any other white background Any other black background Please specify……………………… Please specify…………………… Mixed Other ethnic groups White and black Caribbean Chinese White and black African Other ethnic groups White and Asian Please specify…………………….. Other mixed background Please specify……………………… Prefer not to say Asian or Asian British Indian Pakistani Bangladeshi Other Asian background Please specify………………………
This information is sought under the Equality Act and enables PSS to ensure compliance with the Act and our own internal Dignity at Work policy. Do you consider yourself to be disabled? Yes No If Yes, please give further details: …………………………………………………………………….
RECRUITMENT SOURCE
(This section is to help us monitor the effectiveness of where we advertise) Please indicate from which newspaper/job centre/website or other source you learnt of this vacancy:
PSS Recruitment Website	Word-of-Mouth (please specify):
Job Centre (please specify):	Newspaper (please specify):
External Website (please specify):	Other (please specify):