EQUAL OPPORTUNITIES MONITORING FORM

Port Talbot & Afan Women’s Aid is strivingtowards
equal opportunity in theemployment field.
This form will only beused to aid in monitoring
our practice. It will not be used in the selection
process for thisor any other post.
We appreciate your time taken to complete and return
the form and will maintain confidentialityregarding the contents. /
1)How would you describe your ethnic/racial/cultural origin, please indicate all of the categories which apply to you?
White / Black / Mixed race / Asian / Chinese/ Far East / British / Welsh
Other (please state):
2) Please indicate your age category:
18-25 / 26-35 / 36-45 / 46-55 / 56 and over
3)Do you speak any of the following languages? Please indicate your first language and any others you speak.
English / Welsh / Other (please list)
4)Do you have any form of disability which may affect the way you work?
A disabled person under the Disability Discrimination Act 1995 is described as anyone with “a physical or mental impairment which has a substantial and long term adverse effect on his or her ability to carry out normal day-to-day activities”.
YES / NO
Disability (please state):
5) Gender:
Female / Male / Other
6) Is your gender the same as the gender you were assigned at birth?
YES / NO
7) Do you identify as:
Heterosexual female / Heterosexual male / Lesbian/ gay female / Gay male / Bisexual female / Bisexual male / Prefer not to say / Other:
8)Please indicate your religion:
Baha’i / Buddhist / Catholic / Christian / Hindu
Jewish / Muslim / Sikh / Atheist / Other:
9)Are you a sole carer for a child or relative?
YES / NO
10)Where did you see this job vacancy?