Equal Opportunities Monitoring Form (continued) What is your nationality? Do you require a Work Permit? Yes No Religion or belief please indicate what best describes you: – Buddhist Christian Hindu Jewish Muslim Sikh Agnostic Atheist No religion Other Prefer not to say Gender please indicate what best describes you: – Prefer not Female Male to say Transgender do you currently live or plan to live in the gender opposite to your gender at birth: – Prefer not Yes No to say Sexual orientation please indicate your sexual orientation: – Gay woman Heterosexual Gay man Bisexual Other /Lesbian Prefer not to say The equality Act 2010 defines disability as a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out your normal day-to-day activities which has lasted, or is expected to last, at least 12 months. Alternatively some conditions, such as severe disfigurement, a diagnosis of cancer, HIV infection, multiple sclerosis or a progressive condition, are also covered under the Act. To help us make reasonable adjustments to address your needs for support to overcome barriers in the workplace: Do you consider yourself to have a disability or long-term health condition? Prefer not Yes No to say If yes, which of the following apply to you? (you can select more than one) Blind or visual Deaf or hearing Learning Mental health Mobility impairment impairment Difficulty Condition Physical Prefer not Other disability None of these Impairment to say To ensure we offer you a fair recruitment process, please tell us whether you require any reasonable adjustment should you be invited to interview: Yes No If yes, please provide details: We will endeavour to provide access, equipment or other practical support to ensure that applicants attending interviews are not unfairly disadvantaged. I hereby declare that the information provided on all parts of this form is correct. Signature of applicant: Date:
Equal Opportunities Monitoring Form (continued) What is your nationality? Do you require a Work Permit? Yes No Religion or belief – please indicate what best describes you: Buddhist Christian Hindu Jewish Muslim Sikh Agnostic Atheist No religion Other Prefer not to say Gender – please indicate what best describes you: Female Male Prefer not to say Transgender – do you currently live or plan to live in the gender opposite to your gender at birth: Yes No Prefer not to say Sexual orientation – please indicate your sexual orientation: Heterosexual Gay man Gay woman /Lesbian Bisexual Other Prefer not to say The equality Act 2010 defines disability as a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out your normal day-to-day activities which has lasted, or is expected to last, at least 12 months. Alternatively some conditions, such as severe disfigurement, a diagnosis of cancer, HIV infection, multiple sclerosis or a progressive condition, are also covered under the Act. To help us make reasonable adjustments to address your needs for support to overcome barriers in the workplace: Do you consider yourself to have a disability or long-term health condition? Yes No Prefer not to say If yes, which of the following apply to you? (you can select more than one) Blind or visual impairment Deaf or hearing impairment Learning Difficulty Mental health Condition Mobility Physical Impairment Other disability None of these Prefer not to say To ensure we offer you a fair recruitment process, please tell us whether you require any reasonable adjustment should you be invited to interview: Yes No If yes, please provide details: We will endeavour to provide access, equipment or other practical support to ensure that applicants attending interviews are not unfairly disadvantaged. I hereby declare that the information provided on all parts of this form is correct. Signature of applicant: Date: