National Theatre Wales

Equal Opportunities Monitoring Form

We aim to treat everyone equally, not to discriminate and to build an accurate picture of the make-up of the workforce in encouraging equality and diversity. We need your help and co-operation to enable us to do this, but filling in this form is voluntary. This monitoring form is for statistical purposes only and will be separated from your job application and destroyed once the data has been collated. We thank you for your co-operation.

What is your ethnicity?
Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box
White:
British / Any other white background*
Irish
Mixed:
White & Black Caribbean / White & Black African
White & Asian / Any other mixed background*
Black or Black British
Caribbean / African
Any other Black background*
Asian or Asian British
Indian / Pakistani
Bangladeshi / Chinese
Arab or Other Ethnic group
Arab / Other Ethnic Group*
* Please specify / Prefer not to say
Age
16-24 / 25-29 / 30-34 / 35-39 / 40-44 / 45-49
50-54 / 55-59 / 60-64 / 65+ / Prefer not to say
Gender
Female / Male / Prefer not to say
What is your sexual orientation?
Bisexual / Heterosexual/Straight
Gay Man / Other
Gay Woman/Lesbian / Prefer not to say
* Please specify:
What is your religion or belief?
Buddhist / Sikh
Christian / Other Religion or Belief*
Hindu / No Religion
Jewish / Prefer not to say
Muslim
* Please specify:
Do you speak Welsh?
Yes / A little / No / Prefer not to say
Do you consider yourself to have a disability?
The Disability Discrimination Act defines disability as “A physical or mental impairment which has a substantial and long-tern effect on the person’s ability to carry out normal day to day activities”
Yes / No
If yes, please state the nature of the disability:
How did you first hear about the vacancy?
Newspaper / Print Journal / Which one?
Online Newspaper / Journal / Which one?
Job search website / Which one?
Email alert / Which one?
Social Media / Which one?
Word of mouth
Other / Please specify