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.

1. Gender: Please tick as appropriate:      male................ female..............

2. Age: Please tick as appropriate: 18 - 24 years......... ..25 - 34 years......... 35 - 44 years........... 45 - 55 years............... over 55 years................

3. Marital Status: Married...............Single.............. Divorced.............
Separated............ Widowed........... Living with Partner..............

4. Dependents: Do you have any direct caring responsibilities?
Please indicate number as appropriate:
pre-school children ................school aged children ..................adults..................

5. Ethnic Origin: (Groupings are agreed by the Commission for Racial Equality) To which of these groups do you consider you belong? Tick one only.
Bangladeshi........... Black African.............. Black-Caribbean..............
Black other (please specify).............................................................................................
Chinese................ Indian................. Pakistani.................. White...................
Other Asian (please below)..............................................................................................
Other (please specify).......................................................................................................

6. Disabilities: Are you registered disabled?       Yes.................. No....................
Do you consider yourself to have any disabilities?    Yes...................No....................

7. How did you hear about this position? ……………………………………………………………………………………………….................

8. Are there any comments you wish to make about this form? ………………………………………………………………………………………………..

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