MSF UK and Ireland
Equal Opportunities Monitoring Form
Médecins Sans Frontières (MSF) UK is committed to the principle of equal opportunity in employment.
MSF UK values the diversity of its workforce and is firmly committed to creating a culture of dignity and
respect at work that values the rights of every individual.
We ask you to complete this form to assist us in monitoring who is applying for employment with us, our
adherence to equal opportunities best practice and our progress towards identifying any barriers to
diversity among our workforce.
This form will be separated from your application on receipt, and will not be seen by the interview
panel or used in any way for the purposes of selection. If you are subsequently employed by MSF
UK it may be retained upon your personal file. All information will be treated in the strictest confidence,
and in accordance with the Data Protection Act 1998.
SECTION A: AGE
Please tick the age group you belong to
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16 – 21
22 – 30
31 – 40
41 – 50
51 – 60
61 – 64
65 +
I would prefer not to say
SECTION B: GENDER
What is your gender?
 Male
 Female
 I would prefer not to say
SECTION C: ETHNIC ORIGIN
What is your ethnic group? Choose ONE section from 1 to 5, and then tick the appropriate box to
indicate your cultural background.
1. White
 British
 Irish
 Any other White background (please specify)
2. Mixed
 White and Black Caribbean
 White and Black African
 White and Asian
 Any other Mixed background (please specify)
3. Asian or Asian British
 Indian
 Pakistani
 Bangladeshi
 Any other Asian background (please specify)
4. Black or Black British
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Caribbean
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African
Any other Black background (please specify)
5. Chinese or other ethnic group
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Chinese
Any other (please specify)
 I would prefer not to say
SECTION D: DISABILITY
The Equality Act 2010 defines a disability as ‘a physical or mental impairment which has substantial and
long term adverse effect on a person’s ability to carry out normal day-to-day activities’.
With this definition in mind, do you consider yourself to be disabled?
 Yes
 No
 I would prefer not to say
If yes, please provide a brief summary of your disability if you wish to.
SECTION E: RELIGION AND BELIEF
Please indicate the term which best describes your religion/belief.
 Christian
 Buddhist
 Hindu
 Jewish
 Muslim
 Sikh
 Other (please specify)
 No religion or belief
 I would prefer not to say
SECTION F: SEXUAL ORIENTATION
Please indicate the term which best describes your sexual orientation.
 Bisexual
 Gay man
 Gay woman / lesbian
 Heterosexual / straight
 I would prefer not to say
SECTION G: ADVERTISING
Where did you hear about this opportunity to work for MSF UK / Ireland?
 MSF UK Association
 MSF UK website
 CharityJob
 LinkedIn
 Social media (please specify)
 Other website (please specify)
 Conference / Event (please specify)
 Other (please specify)
 Word of mouth
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