<p> STRICTLY CONFIDENTIAL</p><p>Please complete this form and return with your application to: [email protected] </p><p>Or by post to: Green Park Interim & Executive Search, 3rd Floor, 15 Portland Place, London, W1B 1PT. </p><p>POSITION APPLIED FOR: [insert full job title and employer before locking form]</p><p>APPLICANT NAME: </p><p>HMRC is committed to recruiting, retaining and developing a workforce that reflects at all grades the diverse communities that we serve. It is vital that we monitor and analyse diversity information so that we can ensure that our HR processes are fair, transparent, promote equality of opportunity for all staff, and do not have an adverse impact on any particular group.</p><p>The Senior Civil Service are committed to demonstrating commitment to diversity so your cooperation in providing us with accurate data will ensure that we, not only meet our legal obligations, but more importantly will result in us designing and applying policies and processes that attract and retain a diverse, talented and motivated workforce.</p><p>Any information on this form is strictly confidential and is for statistical purposes only. It will not be seen by anybody directly involved in the selection process.</p><p>No information is published or used in any way that allows identification of an individual, with the exception of the Guaranteed Interview Scheme (GIS) information.</p><p>Do you consider yourself to be disabled? Yes No</p><p>If you have answered yes, please give details of any arrangements or facilities you require to enable you to attend interview (e.g. sign language interpreter, level access etc):</p><p>Any information you provide below will be used for monitoring purposes only – if you need a ‘reasonable adjustment’, then please follow the additional separate process. We will take reasonable steps to meet your particular needs.</p><p>As an Equal Opportunities Employer, we actively encourage applications from disabled people. If you have a disability then you are entitled to apply via the Guaranteed Interview scheme. This means we guarantee to interview (where interviews are part of the selection process), anyone with a disability whose application meets the minimum criteria for the post. By 'minimum criteria' we mean that you must provide us with evidence in your application form that you meet the level of competence required for each competence as well as meeting any of the qualifications, skills or experience defined as essential minimum criteria means essential competences as set out in the advertisement for the post.</p><p>GIS question</p><p>You are eligible to apply via the Guaranteed Interview Scheme if you have a disability as defined by the Equality Act definition of a disabled person and in the Disability Discrimination Act (Northern Ireland). This means you must have:</p><p>1. A physical or mental impairment which has a substantial and long term (over 12 months) adverse effect on your ability to carry out normal day to day activities; or 2. A long term health condition; and 3. You meet the minimum qualifying criteria at the application and testing stages. Your Diversity Information</p><p>1. Based on the definition outlined above, do you consider yourself eligible to apply via the Guaranteed Interview Scheme? Yes No</p><p>2. Is the vacancy based in Northern Ireland? Yes No </p><p>3. Please select your gender: Female Male Prefer not to say </p><p>4. Are you married or in a civil partnership? Yes No Prefer not to say </p><p>5. Please select your current age group: 16-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Prefer not to say</p><p>6. How would you describe your national identity? English Welsh Northern Irish Scottish British Other Prefer not to say</p><p>7. Please select your ethnic group: White Mixed/Multiple ethnic groups Asian/Asian British Black/African/Caribbean/Black British Other ethnic group Prefer not to say</p><p>8. Please state your ethnicity: …………………………………………</p><p>9. What is your sexual orientation? Heterosexual/Straight Gay man Gay woman/Lesbian Bisexual Other Prefer not to say</p><p>10. What is your Religion or belief? Buddhist Christian Hindu Jewish Muslim Sikh Other Religion</p><p>11. What is your flexible working arrangement? None Flexi-time Staggered hours Term-time hours Annualised hours Job-share Flexible shifts Compressed hours Homeworking Other</p><p>12. Do you have caring responsibilities? Yes No Prefer not to say </p><p>12a. Are you a primary carer of a child/children (under18)? Yes No Prefer not to say </p><p>12b. Are you a primary carer of a disabled child/children? Yes No Prefer not to say </p><p>12c. Are you a primary carer of a disabled adult (18 and over)? Yes No Prefer not to say </p><p>12d. Are you the carer of an older person (65+)? Yes No Prefer not to say </p><p>12e. Are you a secondary carer? Yes No Prefer not to say </p><p>13. Where did you hear about this vacancy? …………………………………………………………… </p><p>By completing this form you have helped HMRC better understand how, as an employer, they ensure equality and opportunity for all.</p><p>Thank you for completing this form.</p>