Equal Opportunity Monitoring - Recruitment

Rich Mix is committed to a policy of Equal Opportunities in employment to ensure that all candidates for employment are treated fairly. In order to carry out this policy we are collecting information from all staff on the key characteristics which relate to Equal Opportunities in employment.

Applications are welcome from all sections of the community. We need this information to monitor our progress towards widening diversity among our workforce. The information you provide will be used for statistical monitoring purposes released only as anonymous statistics and will not be seen by members of the Interview Selection Panel.

Full Name
Role
Date of Birth / Gender / Male / Female
I belong to the following ethnic grouping (tick as appropriate)
A: White: / B: Asian or Asian British:
A1: British / B1: Indian
A2: Irish / B2: Pakistani
A3: Any other white background (please specify) / B3: Bangladeshi
B4: Any other Asian background
(please specify)
C: Black or Black British: / D: Mixed or Dual Heritage
C1: Caribbean / D1: White and Asian
C2: African / D2: White and Black African
C3: Any other Black background
(please specify) / D3: White and Black Caribbean
E: Chinese / F: Any other Ethnic Group (please specify)
Do you consider yourself to have a disability? / Yes / No
Do you have any disability for which special arrangements should be made, either in an interviewor employment situation? If so, please specifythe nature of the disability and your requirements:
The completion of this form is voluntary, but the information it contains helps us to monitor and improve our equal opportunities policies and procedures.
I understand that this information may be stored and processed as part of the Rich Mix monitoring of equal opportunities and I give my consent to my details to be used for this purpose.
Sign / Date

THANK YOU FOR YOUR ASSISTANCE.