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1 ETHNIC ORIGIN

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					                                   1.     ETHNIC ORIGIN

Guidelines: Ethnic                 I would describe my ethnic origin as (please tick):
Origin
                                   BLACK including                           WHITE including
We appreciate that some            UK born or settled                        UK born or settled
people including those of
mixed race, may not be
happy with the classification      Caribbean origin                          European origin
used on monitoring forms.                                                    (including UK)
The classifications we have
used are those currently           African origin
recommended         by    the
Commission       for   Racial                                                Other (please specify)
Equality.   If you wish to
classify yourself in some          Asian origin
other way, please use the                                             ____________________________
additional space provided to
do so.
                                   Other (please specify)
                                   _________________________

                                   OR
                                   ____________________________________________________________
                                   ____________________________________________________________
                                   2.     GENDER
                                   I am (please tick):
                                   Male                                              Female

                                   3.     AGE
Guidelines: Disability
                                   Are you:                   16-19                  25-50
We understand that many
employees do not declare                                      20-24                  over 50
disability because of possible
discrimination against them        4.     DISABILITY
by employers in the selection
process. Apex Scotland is
fully committed to improving       a)     I do/do not have any permanent disabilities*
work         and        career
opportunities for disabled         b)     I would/would not require special adaptations/equipments to take up
people.      As a Disability
Symbol user, we offer a                   employment*
Guaranteed           Interview
Scheme which means we are          Please specify
committed to a positive            ____________________________________________________________
approach in the selection of
people      with   disabilities,
                                   ____________________________________________________________
including interviewing all
disabled persons who meet          *If you answer in the affirmative to any of the above questions and are
the      minimum     selection     shortlisted for interview, please contact the Director to ensure that interview
criteria.
                                   arrangements are to your satisfaction.
We would like to know how
many people we attract to
Apex so that we can monitor
the effectiveness of our
policies towards disabled
people..




                                                Issue 1                                  16 March 2000
                            5.   DEPENDANTS

                            Do you have any dependants or children?                 YES/NO

                            If yes, please state how many                           ________

                            6.   CRIMINAL RECORD

                            Are you an ex-offender?                                 YES/NO

                            If yes, please state the number of convictions you have ____

                            How long has elapsed since your last conviction?_________

                            7.   EMPLOYMENT STATUS

                            Prior to making this application were you: Employed_______

                                                                   Unemployed_______

                            If unemployed, please state the period of your unemployment

                            Under 6 months                          1-2 years

                            6-12 months                             over 2 years

                            8.   MEDIA RESPONSE

                            Where did you see this post
                            advertised?_______________________

                            9.   COMMENTS

                            Do you have any comments on our monitoring form?
                            _________________________________________________
                            _________________________________________________



POSITION APPLIED FOR

LOCATION

DATE


Please return this form with your Application.

Thank you.




                                     Issue 1                        16 March 2000

				
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