Market Bosworth Community Library Equal Opportunities Monitoring Form
MBCL is committed to equal opportunities and welcomes all applicants. To help us, please answer these questions by putting a tick in the appropriate box. This information will only be used for monitoring purposes and it will be treated as strictly confidential.
Name:1. Are you: / 2. Do you have a disability?
o / Female / o / Yes
o / Male / o / No
3. How old are you?
o / Under 16 / o / 41 - 50
o / 16 - 24 / o / 51 – 60
o / 25 - 30 / o / 60 and over
o / 31 - 40
4. What is your ethnic group? Choose ONE section, then tick the appropriate box to indicate your cultural background.
White / Black or Black British
o / British / o / Caribbean
o / Irish / o / African
o / Any other white background.
Please specify: / o / Any other Black background.
Please specify:
Asian or Asian British / Mixed
o / Indian / o / White and Black Caribbean
o / Pakistani / o / White and Black African
o / Bangladeshi / o / White and Asian
o / Any other Asian background.
Please specify: / o / Any other Mixed background.
Please specify:
Chinese or other ethnic group
o / Chinese / o / Any other. Please specify:
5. How did you find out about volunteer opportunities at MBCL? Please select the MAIN way you found out about volunteering for the library
o / Aspect / o / MBCL Website
o / Information in library / o / Recommended by a friend
o / Public notice / o / Community group
o / Volunteer Opportunity Resource / o / Other (please specify)
Consent Form for Photographs/ Video/ Audio
I agree that images of me (or the child I have legal responsibility for) may be used by MBCL, or organisations working on their behalf, for promoting or raising funds for MBCL and its programmes.
I agree that MBCL has full editorial rights over photos taken and may make fullest use of them throughout the world in perpetuity by any and all means, and in any and all media.
I understand my right to ask to see any information held about me by MBCL.
Signature * /Date *
(a parent/ guardian must complete this section if the beneficiary is under 16 years
of age)