Male Female Transgender / Transsexual Prefer Not to Say

Diversity Monitoring Questionnaire

We are fully committed to equal opportunities: this includes not discriminating under the Equality Act 2010. The information on this form is for monitoring purposes only in relation to the applications made for solicitor apprenticeship vacancies in the North East. It forms no part of the selection process and will not be viewed individually by the NESA consortium. It will be detached from your application and kept in strict confidence in a locked filing unit by CILEx Law School, who will provide the NESA consortium employers with an overview of the diversity make-up of applications solely for statistical purposes. The diversity monitoring questionnaire responses will be shredded after two months.

______

Gender

Male ☐Female ☐ Transgender / Transsexual ☐ Prefer not to say ☐

______

Marital Status

Married☐Widowed ☐

Civil Partnership☐Separated☐

Single☐Divorced ☐

Prefer not to say☐

______

Sexual Orientation

Heterosexual☐Gay Woman/Lesbian☐

Bisexual☐Prefer not to say☐

Gay Man☐

______

Ethnic Origin

Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong to.

White

English☐Welsh☐

Scottish☐Northern Irish☐

Irish☐British☐

British☐Prefer not to say☐

Other☐ Please specify:

Mixed/Multiple Ethnic Groups

White and Black Caribbean ☐White and Black African☐

White and Asian ☐Prefer not to say☐

Other☐ Please specify:

Asian/Asian British

Indian☐Pakistani☐

Bangladeshi☐Chinese☐

Chinese☐Prefer not to say☐

Other☐ Please specify:

Black/African/Caribbean/Black British

African☐Caribbean☐

Prefer not to say☐

Other☐ Please specify:

Other Ethnic Group

Arab☐Prefer not to say☐

Other☐ Please specify:

Religion

No religion or belief☐Buddhist☐

Christian☐Hindu☐

Jewish☐Muslim☐

Sikh☐Prefer not to say☐

Other☐ Please specify:

______

Age

16-17☐18-21☐

22–30☐31-40☐

41-50☐51- 60 ☐

61-65☐66-70☐

71+☐Prefer not to say☐

______

Disabilities/Health Conditions

Do you have a physical disability, health condition or mental impairment which has a substantial and long-term effect upon your ability to carry out normal day to day activities?

Yes ☐No☐

Prefer not to say☐

If yes, what is the nature of your disability?

______

Do you have any caring responsibilities?

None☐

Primary carer of a child/children under 18☐

Primary carer of disabled adult (over 18)☐

Primary carer of older person☐

Secondary carer (another person carries out the main caring role)☐

Prefer not to say☐

______

THANK YOU FOR COMPLETING THIS FORM