Equality Form

Equality Monitoring 2016/17
Our Equality Policy sets out our commitment to promote equality and diversity in areas such as
recruitment, training and pay to tackle discrimination. Cynon Taf Community Housing Group’s
aim is to provide equality for all and attain a workforce that is representative of the communities
from which it is drawn to secure the widest pool of talent possible.
We are carrying out a monitoring exercise, the purpose of which will be to gather individual
personal information on the diversity of existing employees and volunteers to ensure that our
equality policy is a reality, but also giving us an accurate picture of our organisation and
enabling us to identify and address any inequalities.
The data will be used to ensure that every employee has the same access to training,
promotions and other opportunities. We will also use the data (anonymised), to illustrate our
diversity information in the Annual Report.
All information will be treated as strictly confidential.
Name:
Job Title:
Gender Please tick
Male
Department:

Female
Is this the gender assigned to you at birth?
Other
YES:
Prefer not to say
NO:
Prefer not to say:
What is your ethnic? Please tick one box. 
White:
Mixed Race:
British
English
White & Asian
Irish
Scottish
White & Black African
Welsh
White & Black Caribbean
Other White (Please State)
Other Mixed (Please State)
Asian or Asian British:
Black or Black British:
African
Bangladeshi
Caribbean
Chinese
Indian
Other Asian
Other Black
Pakistani
Other Ethnic Groups:
Gypsy / Travellers
Other Ethnic:
Prefer not to say:
Age Monitoring: Please tick one box. 
Up to 29
30-44
45-64
65+
Prefer not to say
Disability Monitoring:
Do you consider yourself to have a disability or a long-term health condition?
YES/NO/PREFER NOT TO SAY
What is the effect or impact of your disability or health condition?
Would you like to discuss in confidence?
YES/NO
Do you have any caring responsibilities:- Child / Parent / Other / Prefer not to say
What is your Religion/ Belief? Please tick one box
Buddhist
Catholic
Christian
Hindu
Jehovah’s Witness
Jewish
Muslim
Sikh
Atheist
Islam
Agnostic
Prefer not to say
Other (Please state)
Do you or any person who lives with you have religious or cultural requirements that
you would like us to be aware of?
YES/NO
Marital Status: Please tick one box 
Divorced
Single



Living together as partners
Civil Partnership

Married
Widowed

Prefer not to say
What is your sexual orientation? Please tick one box. 
Bisexual
Gay Man
Heterosexual / Straight
Gay Woman / Lesbian
Prefer not to say
Are you pregnant or taking maternity leave?
NO:
YES:

PREFER NOT TO SAY:
Separated 