Equal Opportunities Monitoring Form

Job Applied for*

In accordance with our Equal Opportunity Policy, we are monitoring job applications to ensure that we provide equal opportunities to any job applicant and make sure that discrimination does not occur because of race, sex, sexual orientation, gender reassignment, religion or belief, marital or civil partnership status, age, disability, or pregnancy and maternity.

So that we can assess the success of this policy, we have set up a system of monitoring all job applications. We would be grateful, therefore, if you would complete the questions on this monitoring form and return it with your application form. We have asked for your name in order to enable us to monitor applications at the shortlisting and appointment stage.

All information supplied will be treated in confidence and will not be seen by staff directly involved in the appointment. The monitoring form will be detached from your application form, stored separately and used solely to provide statistics for monitoring purposes.

Thank you for your help.

Confidential

Name*

First NameLast Name

Gender*

MaleFemale

Title*

Marital Status*

Ethnic Origin*

Do you consider yourself to be disabled under the Equality Act 2010? (The Disability Discrimination Act (1995) – still in force under the Equality Act2010 - defines disability as “a physical or mental impairment that has asubstantial, long-term and adverse effect on a person’s ability to carry out day today activities.)*

YesNo

If yes, what is the nature of your disability?(optional)

The information you have provided here will stored either on paper records or a computer system in accordance with the Data Protection Act 1998 and will be used solely to monitor the diversity of Joy Healthcare Solutions Ltd recruitment regarding Equal Opportunity issues.

Age Range*

Date*

Date

Equal Opportunity Recruitment Monitoring Form

Confidential