PRIVATE AND CONFIDENTIAL

EQUAL OPPORTUNITIES SURVEY FORM

Role applied for: Click here to enter text.

The policy and practice of Wadham College requires that all staff are offered equal opportunities within employment and that entry into employment with the College and progression within employment will be determined only by personal merit and the application of criteria which are related to the duties of each particular post and the relevant salary structure. In all cases, ability to perform the job will be the primary criterion.

Subject to statutory provisions, the aim of our policy is to ensure that no applicant or member of staff will be discriminated against on the basis of age, disability, gender reassignment, marriage or civil partnership, pregnancy or parenthood, race, religion or belief, sex, or sexual orientation or is disadvantaged by conditions or requirements which cannot be shown to be permitted by law.Further information on Wadham College’s Equality Policy can be found at:

Our selection criteria and procedures are frequently reviewed to ensure that individuals are selected, promoted and treated on the basis of their relevant merits and abilities.We are committed to an ongoing programme of action to make this policy fully effective. To ensure that this policy is fully and fairly implemented and monitored, and for no other reason, could you please provide the information below. You are of course at liberty not to provide some or all of the information if that is your preference.

The information will be treated in confidence and will not be seen by staff directly involved in the appointment of the role. The form will be detached from your application, stored separately in the HR Department and only used to provide statistics for monitoring purposes. Information from this form may be processed for purposes registered by the College under the Data Protection Act 1998.

Please answer the questions by ticking the appropriate box:

  1. Gender:
/ ☐ / Female / ☐ / Male
☐ / Non-binary gender
  1. Age Group:
/ ☐ / 18-25 / ☐ / 56-65
☐ / 26-40 / ☐ / 66 – 75
☐ / 41-55 / ☐ / Over 75
  1. Marital status:
/ ☐ / Married / ☐ / Civil partner
☐ / Single / ☐ / Cohabiting with partner
☐ / Other. Please specify: Click here to enter text.
  1. Sexual orientation:
/ ☐ / Bisexual / ☐ / Heterosexual/straight
☐ / Gay
☐ / Other. Please specify:Click here to enter text.
  1. Do you have a disability?
/ ☐ / Yes / ☐ / No
  1. If Yes, please tick one or more boxes to describe your disability:

☐ / Partially sighted or visually impaired
☐ / Deaf or serious hearing impairment
☐ / Physical impairment or mobility issues such as using a wheelchair
☐ / A long standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy
☐ / Specific learning disability such as dyslexia, dyspraxia or AD(H)D
☐ / Mental health condition such as depression or an anxiety disorder
☐ / Social/communication impairment such as ASD or Asperger Syndrome
☐ / Other disability not listed already - please describe:
Click here to enter text.
☐ / Please tick this box if you are willing for any disability information provided on this form to be disclosed to the appropriate Disability Officer.
  1. Please share any examples of your experience of good practice for disabled people in the College or improvements that could be made:
Click here to enter text.
  1. Nationality:
/ ☐ / UK
☐ / Other EU
☐ / Other. Please specify: Click here to enter text.
  1. How long have you lived in the UK? (Please tick one box only)

☐ / I am not currently resident in the UK
☐ / Under 1 year / ☐ / 11 - 20 years
☐ / 1-4 years / ☐ / 21+ years
☐ / 5- 10 years
☐ / I have always lived in the UK
  1. Please describe your ethnic origin: (Please tick one box only)
(Ethnic origin questions are not about nationality, place of birth, or citizenship. They are about colour and ethnic group. Citizens of any country may belong to any of the groups indicated. The ethnic original categories used here are based on the 2001 census of the population and are those required by the Higher Education Statistics Agency.)
White
☐ / English / ☐ / Scottish
☐ / Irish / ☐ / Welsh
☐ / Any other White background.Please specify: Click here to enter text.
Black or Black British
☐ / Caribbean
☐ / African
☐ / Any other Black background.Please specify:Click here to enter text.
☐ / Chinese
Mixed
☐ / White and Black Caribbean
☐ / White and Black African
☐ / White and Asian
☐ / Any other mixed background. Please specify: Click here to enter text.
Asian or Asian British
☐ / Indian
☐ / Pakistani
☐ / Bangladeshi
☐ / Any other Asian background. Please specify: Click here to enter text.
☐ / Other ethnic origin. Please specify: Click here to enter text.

Thank you for completing this form

Please return this form to the HR Assistant or HR Manager at Wadham College or email

Updated: January 2015