/ Equal Opportunities Monitoring Form

As a responsible organisation it is our duty to offer an excellent service to both our customers and staff. To help us to meet our legal obligations and to ensure all recruitment candidates are treated fairly, please answer the following questions. Your information will be processed in accordance with the Data Protection Act 1998. This information is given to the mhshomes group on a strictly confidential basis and will not be used as part of the selection process.

General Information
Name: / Date applied:
Role applied for:
Gender: / PLEASE CHOOSEMaleFemaleTransgenderPrefer not to say
Age Group: / PLEASE CHOOSE16-2526-3536-4546-5556-65Over 65Prefer not to say
Marital Status: / PLEASE CHOOSESingleMarried/Civil PartnershipDivorcedWidowedOtherPrefer not to say If other please specify:
Ethnic Origin
Ethnic origin is not about nationality, place of birth or citizenship. It is about colour and broad ethnic group. UK citizens can belong to any of the groups indicated. How would you describe your ethnic origin? Please choose the category which you feel most closely describes this.
Ethnic Origin: / PLEASE CHOOSEWhite: BritishWhite: IrishWhite: OtherMixed: White & Black CaribbeanMixed: White & Black AfricanMixed: White & AsianMixed: Any OtherAsian: IndianAsian: BangladeshiAsian: PakistaniAsian: Any OtherBlack: CaribbeanBlack: AfricanBlack: Any otherChineseChinese: Any OtherPrefer not to say
Religion or Belief
My religion/belief is:
Religion: / PLEASE CHOOSEBuddhistChristianHinduJewishMuslimSikhOtherNo Religion/BeliefPrefer not to say If other please specify:
Disability
A disability is considered to be a physical or mental impairment which has a substantial and long-term effect on a person’s ability to carry out normal day-to-day activities.
Do you consider yourself to have a disability or disabling condition?: / Yes No Prefer not to say
If yes, please specify: / PLEASE CHOOSELearning Difference (autism, dyslexia etc)Mental Health Needs / Survivor of Health SystemPhysical impairmantVisual impairmentA hidden impairmentDeafness or hearing impairmentDeaf and use BSLOther If other please specify:
Sexual Orientation
I would describe myself as: / PLEASE CHOOSEHeterosexual/StraightGay ManGay Woman/LesbianBi-SexualPrefer not to say
Data Protection Act 1998
The information you have provided will be used by mhs homes to create or update records held by us. As the information you have provided contains sensitive personal data, you are required to expressly consent to our processing of such data in the way described above.
If you agree to have your information used in this way, please tick the box

mhs homes group Page 1 Updated Aug 2014