Equal Opportunities Monitoring Form
Confidential
Please complete the following form and return with your completed
application form. The information which you supply is used purely
for monitoring purposes and will not be forwarded to anyone
involved in the selection decision.
Please complete all questions by ticking the appropriate response
or entering the information requested.
Name:
Vacancy reference number:
Vacancy applied for:
How did you hear about this vacancy? Please delete options
that are not appropriate:
 Advertisement in newspaper (please specify):
 Advertisement on RNIB website
 Advertisement on other website (please specify):
 Through job centre
 Through an employment agency (please specify):
 From friend / relative / colleague
 RNIB's iSite
 Other (please specify):
Date of birth:
Age:
Gender: Male / Female (please specify):
Marital status: Single / Married / Other (please specify):
Logo – RNIB supporting blind and partially sighted people
Registered charity number 226227
Ethnic origin:
From the list that follows, please indicate how you prefer to
describe your ethnic origin. Please delete options which are not
applicable.
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Asian Indian
Bangladeshi
Black (African)
Black (Caribbean)
Black (Other)
Chinese
Indian
Irish
Other
Pakistani
White
Disability:
For employment purposes, a person with a disability is identified as
someone with a physical or mental impairment that has a
substantial and long-term adverse effect on his or her ability to
carry out normal day-to-day activities.
For employment purposes, do you have a disability? Please
specify yes or no:
If yes, from the options that follows, please indicate which
best describes your disability. Please delete the option that is
not appropriate:
 Sight loss
 Other disability
Religion:
We are an equal opportunities employer. We do not discriminate
on grounds of religious belief or political opinion. We practise
equality of opportunity in employment and select the best person
for the job.
How would you describe your religion or belief?
Please note for roles in Northern Ireland we monitor the community
background of our employees, as required by the Fair Employment
and Treatment Order 1998. If you choose not to answer this
question we are required to assign a background to you based on
other information. Please delete options that are not appropriate:
Note: It is a criminal offence under Fair Employment legislation for
a person to "give false information ... in connection with the
preparation of the monitoring return".
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Buddhist
Christian (Catholic)
Christian (Other)
Christian (Protestant)
Hindu
Jewish
Muslim
No Religion
Other - Please state
Sikh
Sexual Orientation:
From the list that follows, please indicate your sexual orientation.
Please delete options which are not applicable.
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Bisexual
Gay Man
Gay Woman / Lesbian
Heterosexual
Prefer not to say