EQUAL OPPORTUNITIES MONITORING FORM
(TO BE COMPLETED ON APPLICATION)

People in Action is striving to ensure that all job applicants are given equal consideration irrespective of ethnic origin, nationality, gender, marital status, age or disability. To help monitor the success of our Equal Opportunities Policy, it would be helpful if you would complete and return this form. This information will remain confidential and anonymous.

Please tick as appropriate:

1. Are you       Male................ Female..............

2. Do you have a disability?   Yes...........No................

3. What age band are you in? Up to 19 ..............20-29.............. 30-39.............
40-49............ 50-65........... over 65..............

4. Which of the following do you consider to be your ethnic origin? Tick one only.
White British........................... White Irish.........................White Other..................Chinese...........
Black Caribbean...............White & Black Caribbean.................White & Black African...........White & Asian................Mixed other....................Black African................   Indian................Pakistani............Bangladeshi........... Asian other ..................Black other................. 

Other Ethnic Group (please describe.................................................. ………………………......

THANK YOU FOR YOUR HELP                        Back to Jobs/Vacancies page