Job Reference / Applicant Number:
AO/12/2-
EQUAL OPPORTUNITIES MONITORING INFORMATION
St Mary’s University College is committed to equality of opportunity for all staff and job applicants regardless of sex, marital or civil partnership status, age, ethnicity, religious belief, disability, sexual orientation, political opinion and/ or responsibility for dependants. In order to comply with legislation and assist with the effective implementation of its Equal Opportunity Policy, the College requests that you complete a monitoring form.
This information will be treated in the strictest confidence. Data collected will be processed by anonymous means and in accordance with the Data Protection Act 1998.
St. Mary’s University College is required by the Fair Employment Treatment (N.I. Order) 1998 to monitor the perceived religious affiliation or community background of its employees and of applicants to posts. Whether or not you are from Northern Ireland, you should answer question one below indicating which community or religious background you might be perceived to come from. Even if you no longer practice any religion, legislation still obliges us to classify your perceived religious affiliation/community background, in order to monitor the effectiveness of our policy. Therefore, although your responses below may not reflect your current religious belief, please bear in mind the above point when you complete the questionnaire.
Please complete and return this form to the Human Resources Office in the envelope provided.
DO NOT PUT YOUR NAME ON THIS FORM
1. Community Background
Regardless of whether we practice religion, most of us in Northern Ireland are seen as either
Protestant or Roman Catholic. We therefore ask you to indicate your community background by ticking

the appropriate box:
I am a member of the Protestant community
I am a member of the Roman Catholic community
I am a member of neither the Protestant nor the
Roman Catholic community
Please note that it is an offence under fair employment legislation to give false information to an employer who is seeking that information in order to make a monitoring return. If you do not complete this section we are encouraged to use the
‘residuary method’ of monitoring, which means that we can make a determination on the basis of personal information held on file or on your application form.
2. *If you ticked the box above marked ‘neither Protestant or Roman Catholic’, please indicate which of the following religious beliefs you hold by ticking the appropriate box

Job Reference / Applicant Number:
AO/12/2-
Moslem
Jewish Sikh
Other (Please specify)
3. Gender (Please indicate your gender by ticking

the appropriate box)
Male
Buddhist Hindu
Female
4. Sexual Orientation (Please indicate your sexual orientation by ticking

the appropriate box)
My Sexual Orientation is towards:
Persons of a different sex to me:
(i.e. I am a heterosexual man or woman)
Persons of the same sex as me:
(i.e. I am a gay man or a lesbian)
Persons of both sexes:
(i.e. I am a bisexual man or woman)
I do not wish to answer
5. Marital Status (Please indicate your marital status by ticking  the appropriate box)
Co-habiting / With Partner Separated Single
Married
Civil Partnership
Divorced Widowed
6. Date of Birth (Please state your date of birth in the box below)
7. Dependants (Please indicate if you have any dependants by ticking

the appropriate box)
We understand people with dependants to be those with personal responsibility for the care of a child, the care of a person with an incapacitating disability and / or the care of a dependant elderly person.
Do you have any dependants?
YES NO
If ‘Yes’, please indicate whether you are responsible for the:
Care of a child / children:

Mixed - White and Black
Caribbean
Job Reference / Applicant Number:
AO/12/2-
Care of a person/persons with a disability / disabilities:
Care of an elderly person / persons:
Other:
If ‘Other’ please specify:
St. Mary’s University College uses the categorisation scheme suggested by the Higher Education
Statistics Agency (HESA) which is compatible with the 2001 Census Data.
8. Nationality (Please indicate your place of birth by ticking

the appropriate box)
Northern Ireland
Republic of Ireland
England
Wales
Scotland
Other (please specify)
9. Race / Ethnic Origin (Please indicate which category best describes the ethnic group to which you belong by ticking

the appropriate box)
White
White
– Irish
– British
Irish Traveller
Other White background
Asian or Asian British -
Bangladeshi
Other Asian Background
Chinese
Black or Black British -
Caribbean
Mixed
– White and Black African
Black or Black British - African
Other Black Background
Asian or Asian British - Indian
Asian or Asian British -
Pakistani
Mixed – White and Asian
Other Mixed Background
Any other background (please specify)

Job Reference / Applicant Number:
AO/12/2-
10. Disability (Please tick

the appropriate box)
Under the Disability Discrimination Act a person is deemed to be a disabled person if he or she has a physical or mental impairment which has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities.
Do you consider yourself to have a disability? YES NO
If ‘Yes’ please indicate the nature of your disability by ticking 
the appropriate box(es)
Physical Impairment
Such as difficulty using your arms or mobility issues requiring you to use a wheelchair or crutches
Sensory Impairment
Such as being blind / having a serious visual impairment or being deaf / having a serious hearing impairment
Mental Health Condition
Such as depression or schizophrenia
Learning Disability / Difficulty
Such as Down’s syndrome or dyslexia or cognitive impairment, such as autistic spectrum disorder
Long-Standing or Progressive Illness or Health Condition
Such as cancer, HIV, diabetes, chronic heart disease, or epilepsy
Other (Please specify)
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_______________________________________________________________________
_______________________________________________________________________
Access to this information will be strictly controlled and will not be seen by the shortlisting panel. Monitoring will involve the use of statistical summaries of information in which identities of individuals will not appear. The information will not be available for any other purposes other than equal opportunities monitoring. The information will subsequently be transferred to the monitoring system operated by the Monitoring Officers. There it will be strictly controlled in accordance with the Data Protection Code of Practice. Please note that it is an offence for any person to give false information to another who is seeking that information in order to make a monitoring return.

Thank you for completing this form.
Please return the completed form to:
HR Assistant
HR Office, St. Mary’s University College
191 Falls Road, Belfast, BT12 6FE
Job Reference / Applicant Number:
AO/12/2-