Position applied for: |
Surname
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Forename(s)
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Sex
Male Female
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Date of Birth
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Marital Status
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Single
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Married
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Separated
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Divorced
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Widowed
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Cohabiting
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Prefer not to say
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Do you have any Dependents? Yes / No
If yes, please provide Details
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Armed Forces Information
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Armed Forces Reservist
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Veteran
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Cadet Force Adult Volunteer
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Wounded, Injured Sick Veteran
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Spouse / Partner of Service Personnel
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Combined Cadet Force
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Parent of Service Personnel
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Not Applicable
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Nationality
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Are you related to any Corporation member or employee of Kingston Maurward College?
Yes / NO
If Yes, please provide name and relationship
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Ethnicity
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White – British
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Asian or Asian British - Bangladeshi
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White – European
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Other Asian background
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White – Any other background
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Mixed – White and Black Caribbean
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Gypsy or Traveller
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Mixed – White and Black African
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Black or Black British - Caribbean
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Mixed – White and Asian
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Black or Black British – African
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Any Other mixed background
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Any other Black background
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Chinese
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Asian or Asian British – Indian
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Any other ethnic background
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Asian or Asian British – Pakistani
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Prefer Not to Say
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Religion or Belief
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Christian (Includes Roman Catholic, Church of England, etc.)
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Muslim
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Sikh
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Buddhist
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Jewish
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Hindu
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Any other Religion or Belief
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No Religion or Belief
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Prefer Not to Say
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Sexual Orientation
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Bisexual
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Gay Man
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Gay Woman/Lesbian
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Heterosexual
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Other (please Specify)
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Other (please Specify)
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Prefer Not to Say
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11. Gender Identity
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Is your gender identity the same gender as you were originally assigned at birth? Yes / No / Prefer Not to Say
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12. Disability
The Equality Act 2010 protects employees, job applicants, contract workers and students who fall within the new definition of disability. The Act defines disability as a physical or mental impairment, which has a substantial and long-term adverse effect on a person’s ability to carry out normal day to day activities. Long term is taken to mean lasting for a period greater than twelve months or where the total period is likely to last at least twelve months. This definition includes people with heart disease, diabetes, epilepsy, severe disfigurement, depression, schizophrenia, Down’s syndrome, dyslexia, for example.
Do you consider yourself to be disabled within the definition of the Equality Act 2010?
YES / NO
Asperger’s Syndrome
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Asthma
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Auditory Impairment
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Autistic Spectrum Disorders
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Communication Difficulty
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Cystic Fibrosis
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Diabetes
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Disability Affecting Mobility:
non-wheel
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Disability affecting mobility: Wheelchair
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Dyscalculia
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Dyslexia
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Dyspraxia
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Emotional / Behavioural Difficulties
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Epilepsy
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Language Need
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Learning Difficulty (Moderate)
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Learning Difficulty (Severe)
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Literacy Need
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Medical Condition
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Mental Ill-Health
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Not Disabled
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Not Provided
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Numeracy Need
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Other
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Other Physical Disability
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Temporary Disability
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Visual Impairment
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Yes – Rather Not Say
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You are not obliged to declare a disability and the College recognises that many people who may be considered disabled under the terms of the Equality Act do not require any assistance or support. However for those who may, equipment, computer software, flexible working, other support or reasonable adjustment may be available, so an individual’s impairment would have little or no bearing on their capability to realise their employment potential. If you wish please give further details here of any equipment or support you may need because of your disability to carry out the duties described in job description or during any interview selection process. This may include any special consideration for access.
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13. Consent
I hereby give my consent to Kingston Maurward College to record and process my personal information and sensitive personal data in line with the terms of the Data Protection Act and all other legislative provisions. My consent is conditional upon Kingston Maurward College complying with their legal duties and obligations relating to the recording and use of this information. I understand that if I have sent this form via e-mail it will automatically be deemed that I have provided my consent.
You should be aware that when you email KMC the possibility exists, however minimal, that unauthorised individuals may be able to intercept your message. We recommend as a result you should not use unsecure forms and email to send personal data, such as financial information to KMC.
Signed Date……………………………………………………
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