Recruitment Monitoring Form WGGS.


1. Full Name *


2. Email address:
(please write VERY clearly showing zeros as Ø and underscores and hyphens as distinctly as possible)


3. I am applying for the role of


4. Gender


5. Disability is defined in the Disability Discrimination Act 1995 as a "physical or mental impairment, which has a substantial and long term adverse effect on a person's ability to carry out day to day activities". For example, this can include diabetes, learning difficulties, hearing or speech impediments, arthritis and heart problems.

Do you consider yourself to have a disability as defined above? *


6. If the answer to the above question is YES, what form does your disability take? *


7. Ethnic Origin. *


8. Please indicate your age range *


9. Where did you see this job advertised? *