CONFIDENTIAL
Monitoring Questionnaire
BALTIC is working towards achieving diversity and welcomes applications from all sections of the community.
Why monitor diversity?
We are committed to encouraging equality and diversity in all aspects of employment at BALTIC. This information will help us to ensure recruitment and selection at BALTIC is carried out fairly and effectively and will also help us to identify any barriers to recruitment.
What information will be collected?
This questionnaire asks you to categorise yourself by ethnic group, disability, gender, religion/belief and sexual orientation. This data will be kept on a database and monitored for statistical purposes only.
What will happen to the monitoring form?
The questionnaire will be separated from your application form and will not be seen by those responsible for short-listing and will not therefore, form part of the selection process.
What will the information be used for?
This questionnaire will contain sensitive personal data which will only be processed in accordance with the Data Protection Act 1998. The data will help us to review our employment policies and practices, particularly where equality of opportunity is concerned.
Diversity Monitoring Questionnaire
1. Personal Details
What is the first part of your home postcode?______
2. Ethnic Origin
The groups listed below are ethnic categories used in the 2001 Census, and have not been created by BALTIC.Choose ONE section from A to F, then tick the appropriate box to indicate your cultural background.
A White /
B Mixed, Mixed British, Mixed English, Mixed
Scottish, MixedWelsh, Mixed Irish
English Scottish Welsh IrishAny other white background, please specify / White and Black Caribbean White and Black African
White and Asian
Any other Mixed background, please specify
C Asian, Asian British, Asian English, Asian Scottish,
Asian Welsh, or Asian Irish
Indian
Pakistani
Bangladeshi
Any other Asian background, please specify / D Black, Black British, Black English, Black Scottish,
Black Welsh, or Black Irish
African
Caribbean
Any other Black background, please specify
E Chinese, Chinese British, Chinese English,
ChineseScottish, Chinese Welsh, or Chinese Irish / F
Not declared
Chinese
Any other background, please specify
3. Gender
Are you? Male Female Transgender4. Age
Are you? 16 – 24 25 – 34 35 – 4445 – 54 55 – 64 65 +
5. Religion or Belief
Are you? Anglican Catholic Presbyterian Other Christian Buddhist HinduJewish Muslim Sikh No belief
Other Religion/Belief (please specify)
6. Sexual Orientation
Are you? Heterosexual Homosexual Bisexual Not Declared7. Disability
A disabled person under the Disability Discrimination Act 1995 is described as anyone with “a physical or mental impairment which has a substantial and long term adverse effect on his or her ability to carry out normal day-to-day activities”. This definition can be broken down to help explain the meaning of disability.
- Physical impairment
- Mental impairment
- Substantial
- Long term
- Normal day to day activity
Includes an impairment resulting from or consisting of a mental illness.
The effect of the impairment on ability to carry out normal day to day activities.
Has, or is likely to last at least 12 months.
Normal activity for most people and carried out on a regular basis.
Do you consider yourself to have a disability? Yes No
If yes, please give details
8. Job Listing
Please list below the location where you found this role advertised:
THANK YOU FOR COMPLETING THIS QUESTIONNAIRE
1