Valuing Diversity

EQUAL OPPORTUNITIES

VALUING DIVERSITY

CONFIDENTIAL QUESTIONNAIRE

As a responsible organisation it is our duty to offer an excellent service to both our customers and staff. In order to help us provide genuine equality and opportunity for all, please answer the following questions. This information is given to the mhshomes group on a strictly confidential basis. I consent that the information detailed below may be used within the mhs homes group for the purpose of monitoring and analysis only.

1. Marital Status(please tick)

Single

Married/Civil Partnership
Other (please specify) /
Widowed
Divorced
2. Gender (please tick)

Male

Female / Transgender
3. Sexual Orientation (I would describe myself as:)
Heterosexual/Straight

Bisexual

Prefer not to say / Gay Man

GayWoman/Lesbian
4. Religion/Belief (my religion/belief is:)
Christian (all denominations)

Buddhist

Hindu

Jewish
Prefer not to say / Muslim
Sikh

No Religion / Belief

Other (please specify)
5. Age (please tick the group in which your age falls)

16 – 25 26 – 35 36 – 45 46 – 55

56 – 65 Over 65
6. Ethnic Origin
Ethnic origin is not about nationality, place of birth or citizenship. It is about colour and broad ethnic groups. UK citizens can belong to any of the groups indicated. How would you describe your ethnic origin? (Please tick one box only)
White
White British White Irish White Other
………………………………………………………………………………………………………………………………………………………….
Mixed
White & Black Caribbean White & Black African
White & Asian Any Other Mixed Background
………………………………………………………………………………………………………………………………………………………….
Asian
Indian Pakistani
Bangladeshi Any Other Asian Background
………………………………………………………………………………………………………………………………………………………….
Black
Caribbean African
Any Other Black Background
………………………………………………………………………………………………………………………………………………………….
Chinese
Chinese Any Other Chinese Background
………………………………………………………………………………………………………………………………………………………….
Other
Other Ethnic Group
7. Disability
A disability is considered to be a physical or mental impairment which has a substantial and long-term effect on a person’s ability to carry out normal day-to-day activities. Do you consider yourself to have a disability or disabling condition?

Yes No Prefer not to say
If Yes, please indicate which category/categories best describe your disability
Physical/Mobility Impairment Visual Impairment
Hearing Impairment SpeechImpairment
Learning Difficulties Other (please specify)
Prefer not to say

Thank you for your co-operation

EQUAL OPPORTUNITIES STATEMENT

"The mhs homes group embraces equality and diversity. We are committed to eliminating discrimination, to promoting equality of opportunity in all aspects of our activities as an employer, service provider and business and to recognising and finding value in the difference that individuals can bring to the workplace and to the community."

This information on equality and diversity is also available in other languages, largeprint, Braille or audio format.

HR October 2010