EmailMe Form - Bequest Diversity Monitoring Form

W J Yapp Bequest is committed to diversity and equal opportunities in all aspects of our Home.

“Derbyshire House wishes to provide accommodation for a diverse population. The diversity consists of visible and non-visible differences. It is the harnessing of these differences, which results in a successful, creative and productive home. As a home, Derbyshire House is proactive in setting and sustaining quality standards of training and development in such a way as to value these differences. The home aims to ensure that no individual is unjustifiably discriminated against on the basis of gender or marital status, race, ethnic or national origin, disability, religious or political beliefs, sexual orientation, age, family circumstance or other irrelevant distinction.”

The personal information requested in this form will help us to comply with the law and to ensure that our policies and practices are fair and effective. The information provide will be treated in strictest confidence and processed in accordance with the Data Protection Act 1998.

If you would prefer not to answer any individual questions, then please leave them blank. The responses that you give will assist us greatly in our commitment to diversity.

Title

Applicant's name *

First Last

Date of birth *

Age

Gender
I would idenify myself as:

Female

Male

Prefer not to say

Ethnicity
Which of the following identifies your ethnic origin?

Ethnicity - further information

Disability is defined by the Disability Discrimination Act, covers many people who may not usually have considered themselves disabled. It covers physical or mental impairments with long term, substantial effects on ability to perform day to day activities. Would you consider yourself to have a disability?

Yes

No

If yes, what is the nature of your disability:

Sexual Orientation