Equality & Diversity Monitoring Form

Equality & Diversity Monitoring Form

This form is anonymous and used only for monitoring and improving diversity. It will not influence recruitment decisions.
Role Applying For*
Type the job title you are applying for
Disability & Access
Do you relate to any of these statements? You can choose more then one.*

I am a disabled personI have a disabilityI have a long-term health conditionI have a mental health conditionI am DeafI am deaf, deafened, hard of hearing or hearing impairedI am dyslexic or dyspraxicI am autistic or neurodivergentI am sight impairedI have long-term difficulties with mobility which impact my regular day-to-day lifeNo, I don’t relate to any of theseDon't knowPrefer not to sayOther
If you would prefer to self-identify, please detail:
Gender
What best describes your gender?*

Man (including trans men)Woman (including trans women)Non Binary / Gender QueerPrefer to self-identifyPrefer not to say
If you would prefer to self-identify, please detail:
Are you the same gender as assigned to you at birth?

YesNoPrefer not to say
Ethnic Origin
Asian/Asian British

Asian - BangladeshiAsian - ChineseAsian - IndianAsian - PakistaniAsian - Another Asian/South Asian/East Asian/South East Asian backgrounds
Black/African/Caribbean/Black British

Black/Black British - AfricanBlack/Black British - CaribbeanBlack/Black British - Any other Black/African/Caribbean backgrounds
Mixed/Multiple Ethnic Groups

Mixed - Asian & WhiteMixed - Black African & WhiteMixed - Black Caribbean & WhiteMixed - Any other Mixed/Multiple Ethnic Group backgrounds
White

White - British/English/Welsh/Scottish/Northern IrishWhite - Gypsy or Irish TravellerWhite - IrishWhite - RomaWhite - Any other White backgrounds
Other Ethnic Group

Other - ArabOther - JewishOther - Middle Eastern & North African HeritageOther - West and Central Asian HeritageOther - Any Other Ethnic Group backgroundsPrefer not to sayNot Known
Age
What is your age?*

Under 1616-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+Prefer not to sayNot Known
Sexual Identity
What is your sexual identity?*

AsexualBisexualGay ManGay Woman/LesbianStraight/HeterosexualPrefer to self-identifyPrefer not to sayNot Known
Should be Empty:

Equality & Diversity Monitoring Form

Disability & Access

Gender

Ethnic Origin

Age

Sexual Identity