Equal opportunities monitoring form

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All applicants for roles with Collusion should complete this form. Collusion wants to meet the aims and commitments set out in our 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.

Collusion needs your help and co-operation to enable us to do this. The information provided will be kept confidential and will be used for monitoring purposes only. If you have any questions about the form contact jo@collusion.org.uk.

Please ensure that you complete and submit this form by the application deadline for the relevant job role.

How do you describe your gender? *

Male

Female

Intersex

Non-binary

Prefer not to say

Other:

Is the gender you identify with the same as your gender registered at birth? *

Yes

Prefer not to say

What is your age? *

What is your ethnicity? *

Asian or Asian British: Indian

Asian or Asian British: Pakistani

Asian or Asian British: Bangladeshi

Asian or Asian British: Chinese

Asian or Asian British: prefer not to say

Black, African, Caribbean or Black British: African

Black, African, Caribbean or Black British: Caribbean

Black, African, Caribbean or Black British: Prefer not to say

Mixed or Multiple ethnic groups: White and Black Caribbean

Mixed or Multiple ethnic groups: White and Black African

Mixed or Multiple ethnic groups: White and Asian

Mixed or Multiple ethnic groups: Prefer not to say

White: English

White: Welsh

White: Scottish

White: Northern Irish

White: Irish

White: British

White: Gypsy or Irish traveller

White: prefer not to say

Other ethnic group: Arab

Other ethnic group: Prefer not to say

Other:

Do you consider yourself to have a disability or health condition?

Yes

Prefer not to say

If you have answered YES to the question above, please briefly describe what effect or impact your disability or health condition has on your work.

What is your sexual orientation?
*

Heterosexual

Gay

Lesbian

Bisexual

Asexual

Pansexual

Undecided

Prefer not to say

Other:

What is your religion or belief?

No religion or belief

Buddhist

Christian

Hindu

Jewish

Muslim

Sikh

Prefer not to say

Other:

Do you have caring responsibilities? If yes, please tick all that apply

None

Primary carer of a child/children (under 18)

Primary carer of disabled child/children

Primary carer of disabled adult (18 and over)

Primary carer of older person

Secondary carer (another person carries out the main caring role)

Prefer not to say

Required

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