Hillingdon Mind
Equality and Diversity Monitoring : Clinical Lead (Counselling Services)
Hillingdon Mind is an equal opportunity employer. Our policy is to ensure that no job applicant, employee or volunteer receives less favourable treatment because of age, disability, marriage and civil partnership, pregnancy or maternity, ethnic group, religion or belief, sex, gender reassignment, or sexual orientation.
We recognise that some people may regard some of this information as personal and we have, therefore, included an option in most questions for ‘prefer not to say’. You do not have to complete all of this form but it will help us monitor our recruitment more effectively if you can complete as much as possible and return the form.
All information Hillingdon Mind collects around equality and diversity will be treated confidentially in accordance with the Data Protection Act and will be stored on the Hillingdon Mind database. Access to this information will be restricted to staff involved in the processing and monitoring of this data. It will be used to provide statistical information only
Age :18 – 25 / 26 – 35 / 36 – 45 / 46 – 55 / 56 - 65 / 65+
Gender: / Disability
male / female / Yes / No / Prefer not to say
Gender Re-assignment :
Is your gender identity the same as the gender you were originally assigned at birth? / Yes / No
Ethnic origin:
Asian Bangladeshi / Black African / Mixed parentage white/Asian / White British
Asian British / Black British / Mixed parentage white/black African / White Irish
Asian Indian / Black Caribbean / Mixed parentage white/black Caribbean / White other
Asian Pakistani / Black other / Mixed parentage other / Other ethnicity
Asian other / Chinese
Sexual orientation :
heterosexual
/ straight / gay woman/ lesbian / gay man / bisexual / other
Occupation status:
employed / unemployed / retired / student / volunteer
Housing status:
Owner/mortgage
/ Council/housing association / Renting privately
Shared/sheltered housing / Living with parents
Religion or belief ::
Baha'i / Buddhism / Christianity / Hinduism / Humanism
Islam / Jainism / Judaism / Paganism / Rastafarianism
Sikhism / Zoroastrian / Other (detail) :
Please give your consent below for your information to be stored on our database and used for the purpose of equality and diversity monitoring.
Name: ……………………………………...... Signed: ………………………………………………………
Date: ………………………………………………
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