Homecare Alliance Equality and Diversity Monitoring Form

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Homecare Alliance is dedicated to championing equality and diversity and meeting the aims and commitments set out in its equality policy and under the Equality Act 2010. This includes not discriminating based on protected characteristics and building an accuracte picture of the make up of our workforce and applicant pool.

Completing this form is not compulsary, however we kindly request your help in collecting this diversity data. Your diversity data will be anonymised, treated as confidental and stored securely according to Homecare Alliance's Privacy policy. It will not be published in any way which may identify any individual. The raw data will be kept only for monitoring purposes.
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Please answer each question by choosing one option only, unless otherwise indicated. If you do not wish to answer the question, please choose the option "Prefer not to say" rather than leaving the question blank. If a question is not applicable to you, please choose the option "Not applicable" rather than leaving the question blank.
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Age* This field is required.From the list of age bands below, please indicate the category that includes your current age in years:
16-24
25-34
35-44
45-54
55-64
65+
Prefer not to say
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Sex* This field is required.What is your sex?
Female
Male
Prefer not to say
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Gender* This field is required.Is the gender you identify with the same as your sex registered as birth?
Yes
No
Prefer not to say
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If no, please enter your gender identity:
Woman
Man
Prefer not to say
Other
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The Equality Act 2010 generally defines a disabled person as someone who has a mental or physical impairment that has a substantial and long-term adverse effect on the person's ability to carry out normal day-to-day activities.
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Do you have a physical or mental impairment that qualifies as a disability under the Equality Act 2010?* This field is required.Please refer to the definition on the previous page
Yes
No
Prefer not to say
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Is your ability to perform day-to-day activities limited because of a physical or mental disability, condition or illness which has lasted, or is expected to last, for at least 12 months?
Yes, a lot
Yes, a little
No
Prefer not to say
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Please note that the information you provide in this form will be used for monitoring purposes only.

The Equality Act 2010 requires all employers to make reasobale adjustments for disabled employees. To request a reasonable adjustment, please discuss this with the HR manager.

HR Manager: Naima Ahmed, naima.ahmed@homecare-alliance.co.uk
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Mixed/multiple ethnic groupsPlease tick ALL ethnic groups you consider yourself to belong to
Asian or Asian British
Black, Black British, Caribbean or African
White
South West Asian or North African
Prefer not to say
Other
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Asian or Asian BritishPlease select
Indian
Pakistani
Bangladeshi
Chinese
Prefer not to say
Other
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Black, Black British, Caribbean or AfricanPlease select
Caribbean
African
Prefer not to say
Other
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WhitePlease select
English, Welsh, Scottish, Northern Irish or British
Irish
Gypsy or Irish Traveller
Roma
Prefer not to say
Other
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South West Asian or North African (SWANA)Please select
Arab
Iranian
Kurdish
Turkish
Amazigh
Other
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Other
Prefer not to say
Other
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What is your religion or belief?* This field is required.
No religion or belief
Prefer not to say
Agnostic
Bahá’í
Buddhist
Christian
Hindu
Humanism
Jain
Jewish
Muslim
Pagan
Sikh
Rastafarian
Scientologist
Shinto
Zoroastrian
Other
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What is your sexual orientation?* This field is required.
Heterosexual
Gay
Bisexual
Prefer not to say
Other
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If you went to university, had either (or both) of your parents or carers attend university by the time you were 18?
Yes
No
I don't know
I didn't attend university
Prefer not to say
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What kind of school did you mainly attend between the ages of 11 and 18?* This field is required.
UK non-selective state school (e.g. comprehensive school)
UK Selective state school (e.g. grammar school)
UK fee-paying (private/independent school)
UK fee-paying, supported by a means tested scholarship
Attended school outside the UK
Prefer not to say
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If you finished school after 1980, were you eligible for Free School Meals at any point during your school years?* This field is required.
Yes
No
Not applicable
Don't know
Prefer not to say
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Do you have caring responsibilities? If yes, please tick all that apply.* This field is required.
No
Primary carer of a child/children (under 18)
Primary carer of a disabled child/children
Primary carer of a disabled adult (18 and over)
Primary carer of an older person
Secondary carer (another person carries out the main caring role)
Prefer not to say
Should be Empty: