Equal Opportunities Monitoring Form
Office Use Only
Candidate Number:
Staff Equal Opportunity Monitoring Form
The Equal Opportunity Policy of Age UK Leeds states we will not unjustifiably discriminate against candidates for jobs on the grounds of his or her age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race (including colour, nationality and ethnic origin), religion or belief, gender, and sexual orientation. In order that we can measure the impact of this policy, and continue to develop relevant personnel policies, would you please tick the appropriate boxes. The information on this page will not be taken into account in short listing or interviewing, but will be anonymised and used for regular internal review purposes.
Name (optional): Post Applied For: Corporate Support Manager
(maternity cover)
Gender
I identify my gender as: Male Female Prefer not to say
Is your gender the same as registered at birth?: Yes No Prefer not to say
Age (please tick): 16-24 25-34 35-44 45-54 55-64 65 or over
Race
White – British
White – Irish
White – other background
(please state )…………………
Indian
Pakistani
White & Black Caribbean
White & Black African
White & Asian
Any other mixed background
(please state)……………………....
Black Caribbean
Black African
Bangladeshi
Chinese
Any other Asian background
(please state)…………………
Any other Black background
(please state)…………………...
Arab/Middle Eastern
Any other background (please state)………………
Prefer not to say
Religion or belief
Buddhist
Hindu
Christian
Jewish
Muslim
Sikh
Any other religion or belief
None
Prefer not to say
Please turn over and complete the second page
AUKL. Staff Equal Op Form V.5 16.11.2015
Office Use Only
Candidate Number:
Disability
Do you consider yourself to be a person with a disability? Yes No
This includes people with long term health conditions. If you tell us you have a disability we will make reasonable adjustments to your work arrangements and at interview.
If you have answered yes please use this space to provide details if you wish:
Sexual Orientation How would you describe yourself?
Heterosexual/straight Bisexual Gay man Gay woman/Lesbian Prefer not to answer
How did you hear about the vacancy?
Age UK Leeds website Direct. Gov. website Other (please state)
Please return this form with your application to
Age UK Leeds, the Bradbury Building, Mark Lane, Leeds, LS2 8JA
AUKL. Staff Equal Op Form V.5 16.11.2015
