Bucks Students Union Equal Opportunities Monitoring Form
Bucks Students’ Union Equal Opportunities Monitoring Form
Strictly confidential
Post applied for
Ethnic originReligion/belief
I would describe my ethnic origin asWhich group do you most identify with?
White – BritishNo religion
White – IrishBaha’I
Other White background*Buddhist
Asian or Asian British – IndianChristian
Asian or Asian British – PakistaniHindu
Asian or Asian British – BangladeshiJain
Other Asian background*Jewish
Black or Black British – CaribbeanMuslim
Black or Black British – AfricanOther (please specify)*
Other Black background*
ChinesePrefer not to say
Mixed – White or AsianSexual orientation
Mixed – White and Black CaribbeanWhich of the following best describes you?
Mixed – White and Black AfricanBisexual
Other Mixed background*Gay man
Other Ethnic background *Heterosexual/straight
Prefer not to sayLesbian/gay woman
*Please specify Prefer not to say
Marital status
NationalityAre you?
What is your nationality? Married
Separated/divorced
Single (never married)
Widowed
Prefer not to say
Other (please specify)
Bucks Students Union Equal Opportunities Monitoring Form (February 2016)
Gender
Male Female
Is your gender identity the same as the gender you were assigned at birth?
Yes
No
Prefer not to say
Do you live and work full-time in the gender role opposite to that assigned at birth?
Yes
No
Prefer not to say
Disability
Disability is defined in the Disability Discrimination Act 1995 as a physical or mental impairment which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities. The impairment is long term if it has lasted 12 months or is expected to last at least 12 months.
Do you consider yourself to have a disability?
Yes
No
Prefer not to say
If yes, please tick the type of impairment which applied to you (you may tick more than one type)
Specific learning disability, such as dyslexia or dyspraxia
General learning disability, such as Down’s
Syndrome
Cognitive impairment, such as austic spectrum disorder or resulting from head injury
Long standing illness or health condition, such as cancer, HIV, diabetes, chronic heart disease or epilepsy
Mental health condition, such as depression or schizophrenia
Physical impairment or mobility issues, such as difficulty using arms or using a wheelchair or
crutches
Deaf or serious hearing impairment
Blind or serious visual impairment
Other type of disability
Age
Date or birth
Bucks Students Union Equal Opportunities Monitoring Form (February 2016)