Monitoring Information Monitoring Form This document is to accompany your Application for Employment. Details entered in this part of the form will be held in the HR department. Access to this information will be withheld from the shortlisting panel. Job TitleName of job you are applying for.Are you a United Kingdom (UK), European Community (EC) or European Economic Area (EEA) National? Yes No If 'no', Do you have any evidence of entitlement to enter and work permanently in the United Kingdom (UK, i.e. settled status? Yes No Please indicate which category of the points-based system you think applies.Please supply detail of any permit currently held, including number, validity and expiry date.Monitoring Information To Ensure Compliance With The Equality Act 2010St John's hospice aims to promote equality, diversity and inclusion by being committed to treating all applicants for positions fairly and on merit regardless of race (including ethic origin, colour, nationality and national origin), gender reassignment, marital or civil partnership status, pregnancy or maternity, religion or belief (including philosophical belief), sex, disability, sexual orientation or age. We welcome applications from all sections of the community. St John's Hospice assures you that any information you provide here will only be used to monitor the effectiveness of our policies and procedures. All information will be limited to staff in the HR & Payroll Department. Age Group Under 21 Age 21 - 30 Age 31 - 40 Age 41 - 50 Age 51 - 60 Age 60 + Gender Male Female Gender re-assignment I do not wish to disclose this Ethnic Origin Asian or Asian British Black/Aftrican/Caribbean/Black British Mixed/Multiple ethnic groups White Other ethnic group I do not wish to disclose Asian or Asian British Indian Pakistani Bangladeshi Chinese Other Black/African/Carribbean/Black British African Caribbean Other Mixed/Multiple ethnic groups White and Black Caribbean White and Black African White and Asian Other White English / Welsh / Scottish / Northern Irish / British Irish Gypsy or Irish Traveller Other Other Ethnic Group Arab Other Please select the option which best describes your sexuality Bisexual Gay Man Gay Woman Heterosexual Lesbian I do not wish to disclose this Please indicate your religion or belief Atheism Buddhism Christianity Islam Jainism Sikhism Judaism Hinduism Other I do not wish to disclose this Do you consider yourself to have a disability or long term health condition that impacts your life? Yes No I do not wish to disclose this information If you tell us that you have a disability, this includes a long-term health condition, we can make reasonable adjustments at interview and to where you work and your work arrangements.Please state type of impairment which applies to you. People may experience more than one type of impairment, in which care you may indicate more than one. Physical Impairment Sensory Impairment Mental Impairment Long-standing Illness Learning Disabiliy/Difficulty Other Other DisabilityRelationshipsIf you are related to a member of staff, or have a relationship with an employee of St John's Hospice, please state the relationship.Where did you see this vacancy advertised?Universal JobmatchCharity JobsNHS JobsLancaster CVS BulletinInstitute of FundraisingLancaster GuardianWestmorland GazetteMorecambe VisitorSearch EngineFacebookIndeedJob Centre PlusShop WindowEmployee of St John'sNational NewspaperWord of MouthProfessional JournalRadioFriendFamilySt John's Hospice WebsiteLinkedInGlassdoorOtherIf other please state*Name First Last EmailThis field is for validation purposes and should be left unchanged.