Equal opportunities monitoring form –[Project coordinator and senior researcher – maternity cover]

The McPin Foundation is committed to equal opportunities, fairness of treatment, dignity, and the elimination of all forms of discrimination in the workplace for employees and job applicants. We strive for an environment in which all individuals are able to make best use of their skills, free from discrimination or harassment, and in which all decisions are based on merit.

The information in this form is being gathered to monitor the operation of the McPin Foundation’s Equal Opportunities policies and the effectiveness of advertising media used, and for no other reason. The data will be treated in confidence. It will not be taken into account in assessing information on your application form and is not seen by the short listing panel. Please tick one response per question below or if completing online highlight your answer using a cross (X) and bold your response. E.g.  Age 30-44 X

GENDER

 Female  Male  Non-binary/other (please specify) ______

 Prefer not to say

Do you identify as transgender?

 Yes No  Questioning/unsure Prefer not to say

ETHNICITY Iwould describe my ethnicity as (please tick ONE box):

Asian, Asian British, Asian English, Black, Black British,Chinese, Chinese British,Chinese English,

Asian Scottish, or Asian Welsh Black English, BlackChineseScottish, Chinese Welsh

 IndianScottish, or Black Welshor other ethnic group

 Pakistani Caribbean

 Bangladeshi  African Chinese

 Any other Asian background  Any other Black background Any other background (please specify)______(please specify______(please specify) ______

MixedWhite

 White & Black CaribbeanBritish: Irish

White & Black African English Any other White background

White & Asian Scottish(please specify)______

Any other Mixed background Welsh

(please specify)______ Other(please specify) ______ Prefer not to say

MARITAL STATUSI am: Civil partnership Divorced Married

 Partnered  Single Widowed Prefer not to say

SEXUAL ORIENTATIONI am: Bisexual Gay Heterosexual

 Lesbian Questioning/unsure

 Other (please specify) ______

 Prefer not to say

DISABILITYDo you consider yourself to have a disability? Yes No

Definition of Disability: Section 1 of the Disability Discrimination Act defines a person as having a disability of he/she "has a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day to day activities".

Do you consider yourself to have a sensory disability?Yes / No

Do you consider yourself to have a learning disability? Yes / No

Do you consider yourself to have a physical disability?Yes / No

Do you consider yourself to have a disability related to you mental health?Yes/ No

CARING RESPONSIBILITIES

Do you look after someone from any of the following groups?

A childYes / No

An adultYes / No

 Someone with a sensory, learning or physical disability

 Someone with a disability related to his/her mental health

 Other, please specify______

 Prefer not to say

AGE Under 30 30 - 44 45 or over

RELIGION OR BELIEFI have: No religion or belief Buddhist Christian

 Hindu  Jewish Muslim Sikh

 Other (please specify) ______

 Prefer not to say

MEDIAHow did you hear about this vacancy?

 Job Centre McPin website

 Advert(please state e.g. other website) Other (please state e.g. word of mouth)

______

By completing this form I understand that I give my explicit consent under the Data Protection Act 1998 for the McPin Foundation to retain this information for up to one year after the end of the recruitment exercise.

In order to preserve your anonymity you can send this form by post to:McPin Foundation, 32-36 Loman Street, London, SE1 0EH.

Alternatively please email to where it will be stored separate from your application form and unattached to your email address.