OFFICIAL (OFFICIAL-SENSITIVE when complete)
HR06-01 EQUALITY AND DIVERSITY MONITORING FORM
In order to monitor the effectiveness of our equality and diversity strategy we require
certain personal details about you. The information you provide will be treated in the
strictest confidence and used for statistical/monitoring purposes only.
Title
Mr / Mrs / Ms / Miss / Mx / Dr / Other
Family name (s)
First name (s)
If you are an applicant for a vacancy, please state position applied for:
Are you:
Male
Female
Date of birth:
Ethnic Classification:
Other
Ethnic Classification:
White - British
Black - Caribbean
White - Irish
Black - African
White - Other
Black - British
Chinese
Any other Black background
Indian
Mixed - White & Asian
Pakistan
Mixed - White & Black Caribbean
Bangladeshi
Mixed - White & Black African
Any other Asian background
Mixed - any other mixed background
Other (please specify)
How do you identify your sexual
orientation?
How do you identify your sexual
Bisexual
Gay/lesbian
Prefer not to say
Heterosexual
OFFICIAL (OFFICIAL-SENSITIVE when complete)
Disability
NCA is a Disability Confident Employer.
Do you have disability or long term condition ( such as diabetes, dyslexia, a mental
health condition or a back condition)
Yes
Prefer not to say
No
Religion or Belief:
Religion or Belief:
Buddhist
Christian
Hindu
Humanist
Jewish
Muslim
Sikh
No religious group
Other (please specify)
Status:
Prefer not to say
Status:
Married
Divorced
Civil partnership
Separated
Separated
Living with partner
Single
Single
Widowed
Are you seeking to work:
Prefer not to say
Are you seeking to work:
Full-time
Other (please specify)
Job share
Prefer not to say
Part-time
This section to be completed only if you are applying for a position in either
Northern or Southern Ireland.
We are an Equal Opportunity employer. We practice equality of opportunity in
employment and select the best person for the job. To demonstrate our commitment to
equal opportunity in employment we need to monitor the community background of our
applicants and employees as required by Fair Employment and Treatment (NI) Order
1998.
Regardless of whether they actually practice a particular religion, most people in
Northern Ireland are seen as either Catholic or Protestant. If you are applying for a
vacancy because the collection of this information is a legislative requirement you will be
required to select one of the options below before proceeding with this application.
I am a member of the Roman Catholic community
OFFICIAL (OFFICIAL-SENSITIVE when complete)
I am a member of neither the Roman Catholic nor the Protestant Community
I am a member of the Protestant community
If you do not complete this questionnaire, we are encouraged to use the
“residuary” method, which means that we can make a determination on the
basis of personal information on file/application form.
Guaranteed Interview Scheme (GIS)
If you have a disability defined by the Equality Act, you're eligible to apply via the
Guaranteed Interview Scheme.
0
This means you must have a physical or mental impairment which has a substantial..
and long-term negative effect on your ability to carry out normal day to day activities.0.
If you think you meet the criteria for the GIS, would you like to be considered
for the GIS scheme?
Yes
No