An Equal Opportunity Employer

EQUAL OPPORTUNITIES MONITORING FORM

Central Bedfordshire College College has an Equal Opportunities Policy aimed at treating all applicants fairly in our recruitment practices and selection procedures. We recognise that discrimination may occur on the basis of non job-related factors including ethnicity, age, gender, marital status, sexual orientation, and religion or belief.

In order to ensure that this policy is carried out, it is necessary for us to have some means of monitoring our recruitment and selection activity. Only by such measures will we be able to identify potential sources of discrimination and take remedial action. For this reason alone we would be most grateful if you would answer the following questions. Please note this does not form part of the short listing or selection process and the information is not made available to those responsible for short listing or selection decisions.

Title: / Mr. Mrs. Miss. Ms. Dr. Other
Forenames (in full): / Surname:
Application for appointment as:
Department:
Do you currently work for Central Bedfordshire College? / Yes No
Gender: / Male Female / Date of Birth: / Nationality:

Religion

Bhuddist / Christian / Hindu / Jewish / Muslim
Sikh / None / I do not wish to declare

Ethnic Group

Bangladeshi / Black – African / Black – Caribbean / Chinese
Irish Traveller / Indian / Pakistani / Mixed – White and Asian
Mixed – White and Black / Mixed – White and Black African / White – British / White – Irish
White – Scottish / Other Asian Background / Other Black Background / Other Mixed Background
Other White Background / Other (please specify) / I do not wish to declare

Sexual orientation

Heterosexual / Gay or Lesbian / Bi-sexual / Transgender / I do not wish to declare

Disability (Under the Equality Act, a disability is defined as a physical or mental impairment which has a substantial and long-term adverse effect on a person's ability to carry out normal day to day activities).

Do you consider yourself disabled? / Yes / No / I do not wish to declare
If “Yes”, please provide more details / Physical impairment / Learning Difficulty / Mental ill Health / Other (please specify) ______/ I do not wish to declare
I give consent for Personal Data divulged in applications and forms for employment to be kept on files (both manual and computer) for recruitment, monitoring and employment purposes. Information will be stored securely in line with the Data Protection Act 1998.
Name: / Date: (dd/mm/yy)
Signature:

On receipt, the monitoring form will be separated from the application form and securely stored. It will be treated as strictly confidential and will be used for statistical monitoring only.

Last updated: 23/08/11 Page 1 of 1