Patient visiting at the hospice is by appointment only, please call 0114 236 9911.

Equal Opportunities Form



Home address



Equality & Diversity Monitoring

St Luke’s is required to collect details about an applicant’s age and gender.
This information is collected and used for monitoring purposes only.

Race Relations (Amendment) Act 2000

In order to comply with these regulations, St Luke’s is required to collect details about an applicant’s ethnicity. This information is collected and used for monitoring purposes only.

















Relationships

Disability

Disability Discrimination Act 1995 and 2005

The Disability Discrimination Act protects disabled people. The DDA defines disability as a physical or mental impairment with long term, substantial effects on the ability to carry out normal day to day activities. This includes people with long-term health conditions. If you tell us that you have a disability, we can make reasonable adjustments to where you work, your work arrangements and at interview.


Please tick the type of impairment which applies to you. People may experience more than one type of impairment, in which case you may indicate more than one. If none of the categories apply, please do not mark.

Employment Equality Regulations 2003

In order to comply with these regulations, St Luke’s is monitoring sexual orientation and religion/belief in applications.













Criminal Convictions

Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975

In order to protect certain vulnerable groups within society, St Luke’s is exempt from the provisions of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975.

Applicants are not entitled to withhold any information about convictions, cautions, warnings and reprimands which for other purposes are “spent” under the provisions of the Act. Any information provided will be confidential and will be considered only in relation to posts to which the Order applies. All applicants who are offered employment will be subject to a criminal records check from the Disclosure and Barring Service (DBS) before the appointment is confirmed. This will include details of cautions, reprimands or final warnings, as well as convictions. St Luke’s abides by the strict DBS Code of Practice with regard to disclosure whereby any conviction disclosure would not necessarily be a bar to employment but failure to reveal information relating to any convictions could lead to withdrawal of an offer of employment.



Declaration (please read this carefully before signing this application)

The information in this section is true and complete. I understand that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application, to withdraw any employment contract offered or, if employed, subsequent dismissal without notice if employed by St Luke’s. Where applicable, I consent that St Luke’s can seek clarification regarding professional registration details.

PLEASE NOTE: If completing this form online, all shortlisted candidates will be asked to sign a copy of the application form at interview.

Details entered on this part of the form will be held in the HR Department and will not be made available to the shortlisting panel.