Equal Opportunities Monitoring Form

The Sheiling Ringwood values diversity and works to advance equality. We encourage and welcome applicants from all sections of society. We ask applicants to complete and return an equal opportunities monitoring form with their application to help us check the effectiveness of our recruitment and equality policies.

This information will be treated confidentially and will be separated from you application on receipt. This information will not form part of your application and will not be seen by the short listing/interview panel.

If you chose not to complete the form your application will not be affected. You may also send this form in a separate envelope if you wish.

Name: / Date of birth:
Age: / Gender:

Male Female Transgender
Prefer not to say
Marital status:
Single Married Divorced
Separated Living in partnership / Is your gender identity the same as your gender at birth?

Yes No Prefer not to say

ETHNIC GROUP (please tick the box that best describes your ethnic group)

White:
British
Other British:

English Scottish Welsh
Irish Gypsy or Irish Traveler
Other white background Please specify: ………………………………………….…………………………………………..
Mixed:

White & Asian White & Black African White & Black Caribbean
Other mixed background Please specify: …………………………………………….………………………………………..
Asian, Asian British, Asian English, Asian Scottish, or Asian Welsh:
Indian Pakistani Bangladeshi
Other Asian background Please specify: …………………………………………….………………………………………..
Black, Black British, Black English, Black Scottish, or Black Welsh:

African Caribbean Other Black background Please specify: …………………….………
Chinese, Chinese British, Chinese English, Chinese Scottish, Chinese Welsh:
Chinese Other Chinese background Please specify: …………………………….
Arab and Other Ethnic Background:
Arab Other ethnic background Please specify: …………..……….………
I do not wish to state my ethnic origin

RELIGION OR BELIEF (please tick to indicate)

Baha’i / Buddhism / Christianity
Confucianism / Hinduism / Islam
Jainism / Judaism / Shinto
Sikhism / Taoism / Zoroastrianism
Other / No religion / Prefer not to say

SEXUAL ORIENTATION (please tick to indicate)

Bisexual / Heterosexual / Homosexual
Other / Prefer not to say

ARE YOU CURRENTLY ON ADOPTION, MATERNITY, PATERNITY OR PARENTAL LEAVE? (please tick to indicate)

Yes Maternity / Yes Paternity / Yes Parental
Adoption / No / Prefer not to say

DISABILITY – do you consider yourself to have a disability, impairment, health condition or learning difference?

Yes / No / Unsure
Prefer not to say

PLEASE DESCRIBE YOUR DISABILTY, IMPAIRMENT, HEALTH CONDITION OR LEARNING DIFFERENCE

Physical impairment or a condition that affects your mobility
(for example, requiring use of a wheelchair)
Sensory impairment, such as a visual impairment or hearing impairment
Mental health condition such as depression
Learning difference such as dyslexia
Learning disability or cognitive impairment such as autism or a head injury
Long standing illness or health condition such as heart disease, epilepsy, cancer
Other Please specify: …………………………………………….………………………………………..

IF YOU WISH TO PROVIDE FURTHER INFORMATION PLEASE USE THE BOX BELOW

Equal Ops Form – Oct 15