<p> Equal Opportunities Form</p><p>Name of Applicant: Position applied for:</p><p>Gender: Male Female</p><p>Age: 16-19 20-29 30-39 40-49 50-59 60-65 Over 65</p><p>Ethnic Origin:</p><p>I would describe my ethnic origin as:</p><p>Asian or Asian British - Bangladeshi Mixed – White and Asian Asian or Asian British – Indian Mixed - White and Black African Asian or Asian British – Pakistani Mixed – White and Black Caribbean Asian or Asian British – any other Asian background Mixed – any other Mixed background Black or Black British – African White – British Black or Black British – Caribbean White – Irish Black or Black British – any other Black background White – any other White background Chinese Any other</p><p>The categories above are consistent with those used by the Office of National Statistics (ONS) 2001 census</p><p>Disability: Under the Equality Act 2010 I consider myself to have (please tick the box that applies) No known disability or Dyslexia Dyscalculia Other learning difficulty Visual impairment Hearing impairment Mobility problem Please indicate if you are a wheelchair user Mental Health difficulty ‘Unseen’ disability eg. Asthma, diabetes, epilepsy Disability other than listed Please describe the nature of the disability:</p><p>I agree to this information being shared with the interview panel. (Please tick if you do agree) If you require any special arrangements/adjustments making for the job interview, should you be short-listed, we will contact you to discuss these arrangements further.</p><p>Please state where you saw this vacancy advertised or how you became aware of it: Times Educational Supplement: Academy website:</p><p>Fylde Coast Teaching School Website: Other website, please state:</p><p>Other publication, please state: Other, please state:</p><p>Data collected on this form will be processed for the purpose of equal opportunities in the selection process. All information remains confidential and will not be circulated to the short-listing panel and does not form part of the selection process. Please note however, that it will be necessary to share information about disability during the selection process in order to ascertain what support and assistance may be required. It will form part of the personal, confidential record of the successful applicant.</p><p>FCAT – Recruitment Documents – Blackpool Aspire Academy Signed: Date: Completed forms should be returned to: Judy Woolcock, Bispham Road, Blackpool, Lancashire FY2 0NH or to [email protected]</p><p>Data collected on this form will be processed for the purpose of equal opportunities in the selection process. All information remains confidential and will not be circulated to the short-listing panel and does not form part of the selection process. Please note however, that it will be necessary to share information about disability during the selection process in order to ascertain what support and assistance may be required. It will form part of the personal, confidential record of the successful applicant.</p><p>FCAT – Recruitment Documents – Blackpool Aspire Academy</p>