Southend High School for Boys

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Equal Opportunities Monitoring Form

Southend-on-Sea Borough Council fully supports the principle of equal opportunities in employment and firmly opposes all forms of unlawful or unfair discrimination on the grounds of colour, race, nationality, those with dangerous transmittable diseases (ethnic or national origin), gender, marital status, sexuality, age, disability, trade union membership, religious belief and offending background.

To monitor the effectiveness of our Equal Opportunities Policy you are asked to complete this questionnaire and return it with your completed application form. The information provided will be treated in confidence .


The Council has adopted the ethnic codes recommended by the Commission for Racial Equality. To which of these groups do you consider you belong?


Disability Discrimination

Before ticking the appropriate box below please first read the definition of disability.

The definition of disability, as outlined in the Disability Discrimination Act 1995 is as follows:

"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".

To be protected under the Act an individual must have
i) an impairment which can be physical or mental;
ii) it has to be substantial, this is something more than minor or trivial;
iii) it needs to be long term, i.e., the impairment has lasted or is likely to last in total for at least twelve months or is likely to last for the rest of the life of the person affected; and
iv) it must affect their day to day activities on a regular basis.

The effect an impairment may have on day to day activities is defined in the Act as falling within the following categories:-
1) mobility;
2) manual dexterity;
3) physical co-ordination;
4) continence;
5) ability to lift, carry or otherwise move everyday objects;
6) speech, hearing or eyesight;
7) memory or ability to concentrate, learn or understand; or
8) perception of the risk of physical danger.

Please select:*


I hereby give my consent for the Recruitment Monitoring Information provided on this form to be held on computer or other relevant filing systems and to be shared with other accredited organisations or agencies in accordance with the Data Protection Act 1998.

I certify that to the best of my belief that that information I have entered is true, and I understand that any false information or failure to disclose criminal convictions may in the event of employment, result in dismissal or disciplinary action by the Governing Body.