Bath Mind Equal Opportunities Form

Equality and diversity monitoring form

Bath Mind wants to meet the aims and commitments set out in its equality policy. This includes not discriminating under the Equality Act 2010, and building an accurate picture of the make-up of the workforce in encouraging equality and diversity.

The organisation needs your help and co-operation to enable it to do this, but filling in this form is voluntary.

What is your ethnicity?

The information in this form is for monitoring purposes only. If you believe you need a ‘reasonable adjustment’, then please discuss this with your manager, or the manager running the recruitment process if you are a job applicant.

Confidentiality and Data Protection

Bath Mind is committed to maintaining client confidentiality. All information about you is held securely and not shared with anyone outside our organisation without your permission, or unless exceptional circumstances occur.

If you wish to see the records we hold about you this can be arranged by request to the Chief Executive Officer of Bath Mind. If we believe there is a risk of harm to you or someone else we will inform the appropriate person (such as your GP or other health professional), but we would always endeavour to discuss this with you in advance.

For further information please view our Privacy Policy

Declaration:

• I declare that the information provided by me is accurate to the best of my knowledge.
• If I choose to go ahead and receive counselling through this service, I hereby authorise Bath Mind to store personal information related to me and the service I receive.
• If you are happy to accept the above terms and conditions please tick the following box and click on the button marked submit.