Chair and Members of the NMC Appointments Board

Chair and members of the NMC Appointments Board

Equality and diversity monitoring form

The NMC aims to promote equality of opportunity in all its work, and to do this would like to understand the makeup of all those involved in our work. The NMC will undertake detailed analysis of recruitment monitoring information, investigating and addressing any areas of potential discrimination or negative impact for different applicant groups.

This will enable the NMC to meet its commitment of embedding equality and diversity at the heart of our activities and eliminating discrimination. The data will not be used to identify you.

Please answer all the questions. There is a ‘prefer not to answer’ option for some questions.

This information will be treated confidentially and you do not have to give your name. The information will only be used in creating statistics to assist us in analysing our selection process from an equality and diversity perspective.

1 Please indicate your gender (tick one only).
Female

Male

Transgender

Prefer not to answer

2 Please indicate into which age category you fall at the time of application:

Under 24 24-34 35-44 45-54

55-64 65+ Prefer not to answer

3 Do you have a disability?
Disability in this context means 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’.
Yes

Prefer not to answer

4 Please indicate your sexual orientation (please tick one only).
Bisexual

Gay/ Lesbian

Heterosexual/ Straight

Other (specify if you wish)……………………………………….

Prefer not to answer

5 Please self-define your ethnic group

Choose ONE section from A to F, then tick the appropriate box to indicate your background.

(a) White (b) Black or black British

British Caribbean

Irish African

Any other white background Any other black background write in below please write in below

………………………… ………………………

White and black Caribbean Indian

White and black African Pakistani

White and Asian Bangladeshi

Any other mixed background Any other Asian background

please write in below please write in below

………………………… ………………………

(e) Chinese (f) Other

Chinese Please write in below

Any other Chinese background

please write in below

………………………………………. ……………………………………….

6 Religion (please tick one only)

Buddhist Muslim

Christian Sikh

Hindu Jewish

Prefer not to answer I have no religious beliefs

Other (specify)……………….

Thank you for completing this monitoring form. Please return with your application. This form will be separated from your application on receipt

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