Equal Opportunities Monitoring Form

We are committed to ensuring that all job applicants and members of staff are treated equally, without discrimination because of gender, sexual orientation, marital or civil partner status, gender reassignment, race, colour, nationality, ethnic or national origin, religion or belief, disability or age. This form is intended to help us maintain equal opportunities best practice and identify barriers to workforce equality and diversity. 
Please complete this form and return it to sabrina@playincluded.com. The information on this form will be used for monitoring purposes only and will not be used in any decision affecting you. 
All questions are optional. You are not obliged to answer any of these questions but the more information you supply, the more effective our monitoring will be. All information supplied will be treated in the strictest confidence. It will not be placed on your personnel file.  
Thank you for your assistance.

About the vacancy
Please state which job you have applied for and the closing date given for applications.
Job applied for:		
Closing date for applications:		

Where did you hear about this job (please tick)?
Company Website		Friend		Recruitment company		
Newspaper (please specify)		Other (please specify)		

Age
What is your age (please tick)?
16–17		18–21		22–30		31–40		41–50		
51–60		61–65		66–70		71+		Prefer not to say		

Gender
What is your gender (please tick)?
(If you are undergoing gender reassignment, please use the gender identity you intend to acquire.)

Man		Woman		Intersex		
Non-binary		Prefer not to say		 	 	

If you prefer to use your own term, please specify here …………………………………………………

Ethnic group
How would you describe your nationality and/or ethnicity (please tick)?
A
White:	 	B
Mixed race:	 	C
Asian or Asian British:	 	
British - English, Scottish or Welsh		White and Black Caribbean		Indian		
Irish		White and Black African		Pakistani		
Other White background		White and Asian		Bangladeshi		
 	Other Mixed background		Other Asian background		

D
Black or Black British:	 	E
Chinese and other groups:	 	
Prefer not to say	 	
Caribbean		Chinese		
African		Other ethnic group		
Other Black background		

Sexual orientation
How would you describe your sexual orientation (please tick)?
Heterosexual / straight		Bisexual		Prefer not to say		
Gay man		Gay woman / lesbian		 	 	

Religion or belief
Please describe your religion or other strongly-held belief.
I would describe my religion or belief as:	

I have no particular religion or belief			
Prefer not to say		

Disability
The Equality Act 2010 defines a disability as a "physical or mental impairment which has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities". An effect is long-term if it has lasted, or is likely to last, more than 12 months. 
Do you consider that you have a disability under the Equality Act (please tick)?
Yes		No		
Used to have a disability but have now recovered		Don't know		
Prefer not to say