<p> OXFORD DEANERY</p><p>The Oxford Deanery is committed to Equal Opportunities for all. In order that we may monitor this policy I should be grateful if you would complete the following questionnaire and return this sheet with your Curriculum Vitae and Application Form (if applicable).</p><p>This information is used solely for monitoring purposes and will be treated as confidential. This questionnaire will be detached from your curriculum vitae and/or application form and will be retained in the Medical Personnel Office. This information will not be available for use in shortlisting and selecting staff.</p><p>The personal data on this form is stored on computer and is subject to the provisions of the Data Protection Act 1998.</p><p>1 Name : Surname : ______</p><p>Forename(s) : ______</p><p>2 Post applied for: ______</p><p>3 Job Reference Number: ______</p><p>4 Marital Status : Married  Single </p><p>5 Sex : Male  Female </p><p>6 Date of Birth: ______Age ______</p><p>7 Have you any dependent children? Yes  No </p><p>8 Do you wish to apply for the Flexible Training Scheme (i.e. less than full-time training)? Yes  No  If yes, please inform the Medical Personnel Department at the time of application.</p><p>9 How would you describe your ethnic origin: </p><p>0 White  1 Black Caribbean  2 Black African  3 Black Other  4 Indian  5 Pakistani  6 Bangladeshi  7 Chinese  8 Any other ethnic group  Please Name ______</p><p>10 Country of birth: ______</p><p>11 Nationality: ______</p><p>12 Do you consider yourself to have a Yes  No  disability you would like to tell us about?</p><p>Nature of Disability: ______</p><p>______</p><p>______</p><p>Medpers/Forms/EqualOpForm/16.11.00</p>