Equal Opportunity Monitoring Form

General Details

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

Other white background

Mixed/multiple ethnic groups

Other mixed/multiple background

Asian/Asian British

Other Asian background

Black/African/Caribbean/Black British

African
Caribbean
Prefer not to say
Any other Black/African/Caribbean background

Other Black/African/Caribbean background

Other ethnic group

Arab
Prefer not to say
Any other ethnic group

Other ethnic group

Gender

Other gender

If you prefer to use your own term, please specify here

What is your sexual orientation?

Other sexual orientation

If you prefer to use your own term, please specify here

What is your religion or belief?

Other religion or belief

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

Yes
No
Prefer not to say

Are your day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months?

Yes, limited a lot
Yes, limited a little
No
Prefer not to say

What is the effect or impact of your disability or health condition on your ability to give your best at work?

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.

Age

Socio Economic Background

If you went to University (to study a BA, BSc or higher), were you part of the first generation of your family to do so?

Yes
No
Did not attend University
Prefer not to say

Did you mainly attend a State or fee paying school between the ages of 11-18

UK State School
UK Independent/fee-paying school
Attended school outside the UK
Prefer not to say

(If you changed your type of school during your education, or were educated partly in the UK and partly outside, please select the category that applies to your main place of education in the last two years of your education).

Caring responsibilities

Are you a primary carer for a child or children under 18?

Yes
No
Prefer not to say

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

Equal Opportunity Monitoring Form

General Details

What is your ethnicity?

Socio Economic Background

Caring responsibilities

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