Sapphire Independent Housing Limited

Equal Opportunities Monitoring Form

Sapphire Independent Housing Limited aims to be an equal opportunities employer and selects staff solely on merit irrespective of gender, age, race, skin colour, nationality or ethnic origin, disability, marital status, sexual orientation or religious belief. In order to monitor the effectiveness of our recruitment practices, we ask all applicants to assist us by providing the information below. Completion of any or all of the questions is not a requirement for the application, but we would appreciate your co-operation. This form will be kept strictly confidential and will not be used as any part of the selection process.

By completing and returning this form, you are consenting to Sapphire Independent Housing processing this information for general monitoring purposes to enable us to assess the effectiveness of our equal opportunities policy. If you are employed, the information will be kept and used for ongoing internal monitoring of the diversity within Sapphire Independent Housing.

TitleFirst NameSurname

Gender:MaleFemaleDate of birth?

1. Please tick the description which you feel is the most appropriate of your ethnic origin. Please choose ONE section from A to F and choose the ONE most appropriate box.

A White
British / 
Irish / 
Other(please specify) /  ______
/ C Asian or Asian British
Indian / 
Pakistani / 
Bangladeshi / 
Other (please specify) / 
______
/ E Chinese
Chinese / 
Other (please specify) /  ______
B Mixed
White & Black Caribbean / 
White & Black African / 
White & Asian / 
Other (please specify) /  ______
/ D Black or Black British
Caribbean / 
African / 
Other (please specify) / 
______
/ F Any Other Background
Any other background (please specify) /  ______

2. Do you identify yourself as:

Lesbian/GayHeterosexualBisexual  OtherDon’t wish to state

3. Which of the following, if any, is your religion/belief:

 Atheism /  Christianity /  Judaism /  Don’t wish to state
 Agnosticism /  Hinduism /  Rastafarianism / None
 Baha’i /  Islam (Muslim) /  Sikhism / Other (Please specify)
 Buddhism /  Jainism /  Zoroastrianism (Parsi) / ______

4. Do you consider yourself to be disabled?Yes No

According to the Equality Act 2010, a disability refers to any long-term adverse affect on one’s ability to carry out normal day-to-day activities. This may include problems with mobility, speech, hearing, eyesight, memory, mental health and also conditions such as epilepsy, dyslexia, or degenerative diseases.

5. Where did you hear about this vacancy?

Equal Opportunities Monitoring Form –Housing Operations Manager Jan 16Sapphire Independent Housing is a registered housing provider