Application for Secondment

Equalities monitoring form

Equalities monitoring is the collection of information which helps services ensure that they are providing a fair and inclusive service.

Lewisham Council is committed to monitoring across the nineprotected characteristics.

The information that is provided on this form will remain strictly confidential in accordance with the Data Protection Act. If you are unhappy about answering any particular question, you do not have to.

Ethnicity
What is your ethnic group? / White / English / Welsh / Scottish / Northern Irish / British
Irish
Gypsy or Irish Traveller
Any other White background
Mixed / multiple ethnic groups / White and Black Caribbean
White and Black African
White and Asian
Any other mixed / multiple ethnic background
Asian /
Asian British / Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
Black / African / Caribbean / Black British / African
Caribbean
Any other Black / African / Caribbean background
Other ethnic group / Arab
Any other ethnic group
Prefer not to say
Disability
Under the Equality Act 2010 a person is considered to have a disability if he/she has a physical or mental impairment which has a sustained and long-term adverse effect on his/her ability to carry out normal day to day activities.
Do you consider yourself to be a disabled person? / Yes
No
Prefer not to say
Please state the type of impairment that applies to you.
People may experience more than one type of impairment, in which case you may indicate more than one. If none of the categories apply, please mark ‘Other’ and specify the type of impairment.
Physical impairment, such as difficulty using your arms or mobility issues which means using 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 illness or health condition such as cancer, HIV, diabetes, chronic heart disease or epilepsy / 
Other (please specify) / 
Age
Please select your age group / Under 18
18-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Gender
Are you: / Male
Female
Prefer not to say
Transgender
Is your gender identity different from the gender you were assumed to be at birth? / Yes
No
Prefer not to say
Sexual orientation
How would you define your sexual orientation? / Straight / heterosexual
Gay / lesbian
Bisexual
Other
Prefer not to say
Religion/belief
What is your religious belief? / None
Christian (all denominations)
Buddhist
Hindu
Jewish
Muslim
Sikh
Any other religion/belief
Prefer not to say
Marriage and Civil Partnerships
Are you married or in a civil partnership? * / Yes
No
Prefer not to say

*A person who is engaged to be married is not married and therefore does not have this protected characteristic.

*A divorcee or a person whose civil partnership has been dissolved is not married or in a civil partnership and therefore does not have this protected characteristic.

If any of the protected characteristics that you have outlined above require that you need any particular support, equipment, adaptations or arrangements to help you do your job or to participate in training, please let us know by completing the tick box below.

Needed to Help You to Do Your Job? / Please tick / Please say what type
Communication Support
(human – e.g sign language interpreter)
Communication Support (equipment – e.g. loops, textphones, visual alarms, indicators etc)
Information in particular formats
(sign language, videos, large print, Braille, etc)
Special furniture
Other special equipment
Special transport arrangements
Particular work environment
(lighting, temperature, ventilation, space, etc)
Removal of physical barriers (ramps, lifts, wide doorways, etc)
Adjustment to working hours
Regular breaks/rest periods
Anything else?

All information will be managed in accordance with rights and obligations of the Data Protection Act 1998, taking into account the requirements placed upon us by the Equalities Act 2010.

Information collected will only be processed for the purpose of managing equalities issues.

Please not that all information with be stored securely and will not be disseminated to any third party without your consent.

Information will be processed in a depersonalised form in order to produce management statistics and other reports.