SDPF Equal Opportunities Monitoring Form

SDPF Equal Opportunities Monitoring Form

NHS Education for Scotland /
Scottish Dental Postgraduate Fellowship – Quality Improvement
Equal Opportunities Monitoring Form

We want to ensure that the Scottish Dental Postgraduate Fellowship scheme is open to all dentists and DCPs working the PDS and GDS. The only way we can ensure there is equal opportunity is to monitor applications we receive and compare the profile of people who apply with those appointed. Therefore this form asks you for your professional role, ethnic origin, gender, disability, religion, sexuality and age.

The information you provide in this form is confidential and is NOT used in the selection process.

1. Do you work in the: / GDS / PDS / Both
2. Are you a: / Dentist / DCP
3. Are you: / Male / Female
4. Have you undergone, are you going to, or do you intend to undergo gender reassignment? For example this includes having changed your sex (gender).
Yes / No / Prefer not to answer
5. What is your date of birth?
6. Do you have a physical or mental health condition or disability that:

• has a substantial effect on your ability to carry out day to day activities?

• has lasted or is expected to last 12 months or more?

Yes / No / Prefer not to answer
If you answered ‘yes’, please tick if it is any of the following
Learning disability
Learning difficulty
Physical impairment
Sensory impairment
Development disorder
Long standing illness
Mental health condition
Other, please describe below
Prefer not to answer

SDPF Equal Opportunities Monitoring Form

7. What is your ethnic group?
White - Scottish
White - Other British
White - Irish
White - Gypsy/Traveller
White - Polish
White - Other
Mixed or Multiple Ethnic Group
Asian - Pakistani, Pakistani Scottish or Pakistani British
Asian - Indian, Indian Scottish or Indian British
Asian - Bangladeshi, Bangladeshi Scottish or Bangladeshi British
Asian - Chinese, Chinese Scottish or Chinese British
Asian - Other
African - African, African Scottish or African British
African - Other
Caribbean or Black - Caribbean, Caribbean Scottish or Caribbean British
Caribbean or Black - Black, Black Scottish or Black British
Caribbean or Black - Other
Other Ethnic Group - Arab, Arab Scottish or Arab British
Other Ethnic Group - Other
Prefer not to answer
8. To which religion, religious denomination or body do you actively belong?
(Christianity) - Church of Scotland
(Christianity) - Roman Catholic
Christianity (other)
Other faith / belief
Buddhism
Hinduism
Sikhism
Judaism
Islam
No religion (none)
Prefer not to answer
9. Which of the following best describes your sexual orientation?
Bisexual
Gay Man
Heterosexual
Lesbian / Gay Woman
Other
Prefer not to answer