LiverpoolCity Council is an Equal Opportunities Employer. This means that all applicants for jobs in the

service of the Authority will receive equal treatment irrespective of their race,gender, marital status, age,

disability, religious beliefs, sexual orientation or employment status. Theinformation you provide on this

form will assist us in monitoring the effects of our equal opportunitiespolicy in recruitment and selection

and will help us to develop and improve.

1. JOB DETAILS – Please provide details of the job for which you are applying
Job title: / Job reference number:
2. PERSONAL DETAILS
Title: / First name(s): / Last name: / Date of birth:

The following categories are consistent with the protected characteristics introduced by the Equality Act 2010

3. CULTURAL AND ETHNIC ORIGIN – Please √ relevant box
Asian or Asian British / Asian British
Bangladeshi
Indian
Pakistani
Any other Asian Background / Black or Black British / African
Black British
Caribbean
Nigerian
Somali
Any other black background
Chinese or other ethnic group / Chinese
Gypsy
Irish Traveller
Roma
Yemeni
Other / Mixed / White and Asian
White and Black African
White and Black Caribbean
Any other mixed background
If other please specify:
White / White British
White Irish
Polish
Slovakian
CzechRepublic
Any other white background / Prefer not to say
4. RELIGION/BELIEF Please √ relevant box
Please select appropriate category: / Buddhist / Christian / Hindu / Jewish
Muslim / Sikh / Any other
religion / belief / No religion /
belief
Prefer not to say / If ‘other’ please specify:
5. GENDER IDENTITY Please √ relevant box
Gender: / Male
Female
Prefer not to say / Do you identify as transgender?
For the purposes of this question ‘transgender’ is defined as an individual who lives or wants to live, in the gender opposite to that they were assigned at birth / Yes
No
Prefer not to say
6. SEXUAL ORIENTATION Please √ relevant box
Please select appropriate category: / Bisexual / Gay
Man / Gay
Woman
/ Lesbian / Heterosexual / Straight / Prefer not
to say
7. DISABILITY Please √ relevant box
Do you consider yourself to be a disabled person? / Yes No Prefer not to say
If yes, please give details:
8. AGE GROUP Please √ relevant box
Age group : / Age 16 or under / 17 – 24 / 25 – 35 / 36 – 45
46 – 55 / 56 – 65 / 66 or over / Prefer not
to say
9. RELATIONSHIP STATUS Please √ relevant box
Please select appropriate category: / Divorced / Married / Single / Civil Partnership
Domestic
Partner / Legally Separated / Living
Together / Widowed
Widowed With
Surviving Pension / Prefer not to
say / If ‘other’ please specify:
10 . PREGNANCY/MATERNITY (FEMALE APPLICANTS ONLY) Please √ relevant box
Are you pregnant or have you had a baby in the last 6 months? / Yes No Prefer not to say
SUPPLEMENTARY INFORMATION - Please identify if you would like any support or adjustments to be made to enable you to take part in the selection process for reasons such as religion, disability, medical or maternity
Please state:
(if applicable)