Equality And Diversity Monitoring Form
01.05.2015
Equality and Diversity Monitoring Questionnaire
The Welsh Football Trust is committed to making Football accessible to all. This will be
accomplished by upholding the principles of equality in all aspects of our business. We will
audit and monitor our business practices regularly, and take appropriate steps if it appears that
our commitment to equality is not being delivered effectively.
Without this data, it will not be possible to identify any current areas of under-representation or
potential inequalities, and as such, it will make it much more difficult for us to tackle these
issues. This work is being carried out as part of our responsibilities under the Equality Act, 2010
and as part of the accreditation process for the Equality Standard for Sport.
This form is optional and anonymous. It does not constitute any part of the recruitment and
selection process and is separated from the application form on receipt by a member of staff
who is not involved in the recruitment and selection process.
Position Applied For: _________________________________________________________
Gender
Please place a tick in the box that applies:
Male
Female
I would prefer not to answer this question
Sexual Orientation
Please indicate which of the following best describes how you think about yourself by ticking
one of the boxes below:
Bisexual
Gay man
Gay woman/lesbian
Heterosexual/straight
Other, please write in:
I would prefer not to answer this question
Welsh Football Trust
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Equality And Diversity Monitoring Form
01.05.2015
Age
Your age is, please tick the box that applies:
16-20 years old
21-30 years old
31-40 years old
41-50 years old
51-60 years old
61–70 years old
71 years +
I would prefer not to answer this question
Disability
Do you consider your day-to-day activities limited because of a health condition or disability /
impairment which has lasted, or is expected to last, at least 12 months?
Yes, limited a lot
Yes, limited a little
No
I would prefer not to answer this question
If yes, how would you describe your impairment? Please tick all the boxes that apply to you:
Deaf or hard of hearing
Blind or partially sighted
Physical impairment (I do not use a wheelchair)
Physical impairment (I am a permanent wheelchair user)
Learning difficulty (e.g. movement co-ordination difficulty – dyspraxia, dyslexia etc.)
Learning disability (e.g. Downs Syndrome etc.)
Mental health condition (e.g. depression, stress etc.)
Other condition, please write in:
I would prefer not to answer this question
Welsh Football Trust
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Equality And Diversity Monitoring Form
01.05.2015
Ethnic Origin:
What is your ethnic group? Please choose from one category A-E then tick one box only.
A. White
Welsh
English / Scottish / Northern Irish / British
Irish
Gypsy or Irish Traveller
Any other White background, please write in:
B. Mixed / multiple ethnic groups
White and Black Caribbean
White and Black African
White and Asian
Any other mixed / multiple ethnic background, please write in:
C. Asian / Asian British
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background, please write in:
D. Black / African / Caribbean / Black British
African
Caribbean
Any other Black / African / Caribbean background, please write in:
E. Other ethnic group
Arab
Any other ethnic group, please write in:
I would prefer not to answer this question
Religion
No religion
Christian (all denominations)
Buddhist
Hindu
Jewish
Muslim
Sikh
Any other religion, please write in:
I would prefer not to answer this question
Welsh Football Trust
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Equality And Diversity Monitoring Form
01.05.2015
Languages
What is your main language? Please tick one box:
Welsh
English
Other, please write in (including British Sign Language):
I prefer not to answer this question
Can you understand, speak, read or write Welsh? Please tick all that apply:
Understand spoken Welsh
Speak Welsh
Read Welsh
Write Welsh
None of the above
I prefer not to answer this question
____________________________________________________________________________
Where did you find out about the job vacancy for which you are applying?
Welsh Football Trust website
Other website
Please state:
Agency
Please state:
Newspaper
Please state:
Job centre
Other (please specify):
Thank you for taking the time to fill out this survey
Welsh Football Trust
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