Equal Opportunities Monitoring Form

Confidential Information App No (for office use only)

The information provided on this form is not to be used to make decisions about who is recruited. The form will not be seen by the Shortlisting/Interview Panel. It will be stored and utilised by the Human Resources Department who will use the information to improve and review equality in recruitment and overall service delivery.

Please complete this form in full

Surname/family name
Forenames/first names
Gender	Male Female
Preferred title	MRMRSMSMISS Other (please specify)
Date of birth

Which best describes your racial or cultural origins?

White	British Irish Any other white background (Please specify)
Mixed/Dual Heritage:	White and Black Caribbean White and Asian White and Black African Any other mixed background (Please specify)
Asian or Asian British:	Indian Pakistani Bangladeshi Any other Asian background
Black or Black British:	Caribbean Somali Other African Any other black background (Please specify)
Chinese:	Any Chinese background
Any other Ethnic group:	Yemeni Other Arabic Any other ethnic group (Please specify)
Please indicate your religion or belief:	Baha’I Buddhism Christianity Hinduism Islam Jainism Judaism Sikhism Rastafarianism Other (please specify)

Do you consider yourself to be disabled?	Yes No
Please state the type of impairment which applies to you.

How did you find out about this position?	esg website Job Centre National Publication (please specify) Local Publication (Specify) Internet (Specify)