H e e l e y C i t y F a r mR i c h a r d s R o a d , S h e f f i e l d S 2 3 D TT e l : ( 0 1 1 4 ) 2 5 8 0 4 8 2 F a x : 2 5 5 1 4 0 0 C a f é : 2 5 8 0 2 4 4Email : jobs@heeleyfarm.org.uk Interne t : www.hee leyfarm.org.uk

Heeley City Farm Job Application Equality of Opportunity Monitoring Form

Please complete this form as fully as possible. It will be separated from your application form when it is received and will be used for monitoring purposes only. The information given on this sheet will not be used to make decisions about who is recruited and will not be seen by the Shortlisting/Interview Panel. It will be stored securely by the Human Resources Section who will use the information to improve equality in recruitment and overall service delivery

Position applied for

Your date of birth _ _/_ _ /_ _ _ _

What is your racial or cultural origin (Please describe in your own words)

Do you consider yourself to have a learning difficulty or disability? (If ‘yes’, please describe in your own words)

Are you registered disabled? Yes/No

Employment Status (Please tick opposite)

Employed Full-Time

Employed Part-Time

Unemployed for less than one year

Unemployed for more than one year

How did you hear about the job you are applying for?