BOLTON CARERS SUPPORT Equality and Diversity Form

Equality and Diversity Monitoring Form

Bolton Carers Support wants to meet the aims and commitments set out in our Equal Opportunities in Recruitment policy. This includes not discriminating under the Equality Act 2010, and identifying whether our job vacancies are encouraging equality and diversity.

Filling in this form is voluntary. The information you provide is confidential, separated from your application / not used in the recruitment process, and only used to provide a summary report back to HR regarding actions needed to encourage equality and diversity in future recruitment. Please tick / mark in BOLD all that apply

Gender Male Female Prefer not to say

Are you married or in a civil partnership? Yes No Prefer not to say

Age

BOLTON CARERS SUPPORT Equality and Diversity Form

16 – 24

25 – 29

30 – 34

35 – 39

40 – 44

45 – 49

50 – 54

55 – 59

60 – 64

65+

BOLTON CARERS SUPPORT Equality and Diversity Form

Prefer not to say

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

BOLTON CARERS SUPPORT Equality and Diversity Form

English

Welsh

Scottish

Northern Irish

Irish

British

BOLTON CARERS SUPPORT Equality and Diversity Form

Prefer not to say

Any other white background, please write in:

Mixed / multiple ethnic groups

BOLTON CARERS SUPPORT Equality and Diversity Form

White and Black Caribbean

White and Black African

White and Asian

BOLTON CARERS SUPPORT Equality and Diversity Form

Prefer not to say

Any other mixed background, please write in:

Please continue overleaf

Asian / Asian British

BOLTON CARERS SUPPORT Equality and Diversity Form

Indian

Pakistani

Bangladeshi

Chinese

BOLTON CARERS SUPPORT Equality and Diversity Form

Prefer not to say

Any other Asian background, please write in:

Black / African / Caribbean / Black British

African Caribbean Prefer not to say

BOLTON CARERS SUPPORT Equality and Diversity Form

Any other Black / African / Caribbean background, please write in:

Other ethnic group

Arab Prefer not to say

Any other ethnic group, please write in:

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

Yes No Prefer not to say

What is your sexual orientation?

BOLTON CARERS SUPPORT Equality and Diversity Form

Heterosexual

Gay woman / lesbian

Gay man

Bisexual

BOLTON CARERS SUPPORT Equality and Diversity Form

Prefer not to say

If other, please write in:

What is your religion or belief?

BOLTON CARERS SUPPORT Equality and Diversity Form

Buddhist

Christian

Hindu

Jewish

Muslim

Sikh

BOLTON CARERS SUPPORT Equality and Diversity Form

No religion or belief

Prefer not to say

If other, please write in:

Do you have caring responsibilities? If yes, please tick all that apply

None

Primary carer of a child / children (under 18)

Primary carer of a disabled child / children

Primary carer of an adult

Secondary carer (another person carries out the main caring role)

Prefer not to say

Thank you

November 2016 Review date: November 2018