EQUAL OPPORTUNITIES MONITORING FORM
CONFIDENTIAL
Our organisation is committed to ensuring that all job applicants and employees are treated equally and not
discriminated against on the grounds of gender, colour, race, nationality, marital status, religion or belief,
sexual orientation, disability or age. This form assists 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. We would be grateful if you would fill in this form and return it with your
application. You are not obliged to answer all the questions, but the more information you supply, the more
effective our monitoring will be. All information supplied will be treated in the strictest confidence. This form
will be separated from your application on receipt and during the recruitment process.
Position applied for
Date of application
Location
Where did you hear about the
vacancy?
Gender
☐ Male
Age Range
☐ 16-24
RG Carter Job
Alerts
Recommendation/
☐
Word-of-mouth
☐
☐ LinkedIn
☐ Advertisement
☐ Event
☐ Other
☐ Female
☐ 25-34
Do you consider yourself to have a disability?
☐ Other
☐ 35-44
☐ 45-54
☐ Yes
☐ No
☐ 55-64
☐ 65+
☐ Prefer not to say
Are there any reasonable adjustments you would wish us to make? Please specify below:
Ethnic origin – How would you best describe your ethnic origin? (please tick one)
White
☐ British
☐
Irish
☐
Other
Mixed White & Black
Asian or Asian
British
Black or Black
British
☐ Caribbean
☐
African
☐
Asian
☐ Other
☐ Indian
☐
Pakistani
☐
Bangladeshi
☐ Other
☐ Caribbean
☐
African
☐
Other
Other Ethnic Group
☐ Chinese
☐
Arab
☐
Other
☐
Prefer not to
say
Sexual orientation – How would you best describe your sexual orientation? (please tick one)
Other/ Prefer not to
☐ Heterosexual
☐ Homosexual
☐ Bisexual
☐
say
Religion/ belief – how would you best describe your religion/ belief? (please tick one)
☐ Christian
☐ Muslim
☐ Sikh
☐ Other:
☐ Jewish
☐ Hindu
☐ No religion
☐ Buddhist
Prefer not to
☐
say
For the purposes of compliance and the Data Protection Act 1998, please note that by signing this form, you
give consent to the processing of data supplied above in connection with monitoring compliance and equal
opportunities obligations. You also agree to the storage of this information on manual and digital files.
Signed
Date