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Equality and Diversity Monitoring Form
1.
Gender
Male
Female
Intersex
Non-binary
Prefer not to say
Other (please specify)
2.
Is the gender you identify with the same as your gender registered at birth?
Yes
No
Prefer not to say
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
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)
5.
Do you consider yourself to have a disability or a health condition?
Yes
No
Prefer not to say
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.
7.
What is your religion or belief?
No religion or belief
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
Prefer not to say
Other (please specify)
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)
9.
Where did you hear about this role?
