Equality and Diversity Monitoring Form

Question Title

* 1. Gender

Male 

Female 

Intersex 

Non-binary 

Prefer not to say 

Other (please specify)

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

Yes

Prefer not to say

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* 3. Age

16-24 

25-29 

30-34 

35-39 

40-44 

45-49 

50-54 

55-59 

60-64 

65+ 

Prefer not to say

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* 4. What is your ethnicity?

Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box.

White British

Any other white background

Any mixed background

Indian

Pakistani

Bangladeshi

Chinese

Any other Asian background

Caribbean

African

Any other black background

Prefer not to say

Other (please specify)

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

Yes

Prefer not to say

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* 6. What is the effect or impact of your disability or health condition on your work?

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

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* 7. What is your religion or belief?

No religion or belief

Buddhist

Christian

Hindu

Jewish

Muslim

Sikh

Prefer not to say

Other (please specify)

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* 8. Do you have any caring responsibilities? Tick all that apply

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

None

Other (please specify)

Equality and Diversity Monitoring Form

Question Title

* 1. Gender

Question Title

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

Question Title

* 3. Age

Question Title

* 4. What is your ethnicity?Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box.

Question Title

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

Question Title

* 6. What is the effect or impact of your disability or health condition on your work?The information in this form is for monitoring purposes only. If you believe you need a ‘reasonable adjustment’, then please discuss with the manager running the recruitment process if you are a job applicant.

Question Title

* 7. What is your religion or belief?

Question Title

* 8. Do you have any caring responsibilities? Tick all that apply

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* 9. Where did you hear about this role?

* 4. What is your ethnicity?

Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box.