Equal Opportunities Monitoring Form

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You are not obliged to complete this form but by monitoring age, gender, race, faith and disability among job applicants we are able to see whether or not our equality statement is working in practice. This information will be treated as confidential; it will remain anonymous, and it is separate from the job application form.

Gender & Gender Identity

Male

Female

Nonbinary/Genderqueer

Trans man

Trans woman

Prefer not to say

Clear selection

Is your gender identity the same as you were assigned at birth?

Yes

Clear selection

Sexual Orientation. Do you consider yourself as:

Heterosexual

Gay

Bisexual

Lesbian

Other

Prefer not to say

Clear selection

Marriage and civil partnership

Married

Single

Civil partnered

Prefer not to say

Clear selection

Do you consider yourself to have a disability?

Yes

Clear selection

If you answered "yes" to the previous question, which of the following apply?

Blind or visually impaired

Learning difficulty

Mental health

Mobility/other disability

Deaf or hearing impaired

Prefer not to say

Other:

Pregnancy & maternity. Are you:

Pregnant

Recent parent

Neither pregnant nor a recent parent

Prefer not to say

Clear selection

How would you describe your ethnic origin?

Latin American

Black Caribbean

Black African

White European

Chinese

Japanese

North African

Indian

Pakistani

Bangladeshi

Black - Other

Asian - Other

White - Other

Other:

Clear selection

How would you describe your faith?

Christian

Jewish

Muslim

Buddhist

Sikh

Hindu

Rastafarian

Humanist

Agnostic

Atheist

None

Prefer not to say

Other:

Clear selection

Age

16-20

21-25

26-35

36-45

46-55

55 -54

65+

Prefer not to say

Clear selection

Submit

Clear form

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