Equal Opportunities Monitoring Form

This information will be used solely for monitoring purposes.
The Horniman Museum and Gardens recognises and actively promotes the benefits of a diverse workforce and is committed to treating all with dignity and respect regardless of race, gender, disability, age, sexual orientation, religion or belief. We therefore welcome applications from all sections of the community.
This information will be kept securely and not made available to anyone before or during short-listing. It will not be used in deciding whether to shortlist you for interview. All information will be retained in accordance with the Horniman’s retention of records arrangements.
Full name / Trustee Role
Date of Birth / Gender / FemaleMale
I belong to the following ethnic grouping (check as appropriate)
White / Black or Black British
British / Caribbean
Irish / African
Other (please specify) / Other (please specify)
Asian or Asian British / Of Mixed Race
Indian / White & Black Caribbean
Pakistani / White & Black African
Bangladeshi / White & Asian
Other (please specify) / Other (please specify)
Chinese / Any other ethnic group
Chinese
I belong to the following nationality
For the purpose of equal opportunities monitoring only, you may if you wish disclose the following:
Religion / Sexual Orientation
The Disability Discrimination Act defines a disability as a physical or mental impairment which has a substantial and long term (i.e. more than 12 months) adverse affect on a persons ability to do normal daily activities. You may still be considered to have a disability if you are not currently adversely affected but the impairment is likely to recur.
Do you consider yourself to have a disability?
Yes / No
Do you have any disabilities for which special arrangements should be made, either in the recruitment process itself or as a member of the Board of Trustees? If so, please specify the nature of the disability below
The completion of this form is voluntary, but we appreciate it when candidates take the time and trouble to do so, because the information it contains helps us to monitor and improve our equal opportunities policies and procedures.
I understand that this information may be stored and processed as past of the Trust’s monitoring of equal opportunities and I give my consent for my details to be used for this purpose.
Signature:
Date:

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