DIVERSITY AND INCLUSION MONITORING FORM

GLE Group aims to ensure that all applicants for work and employees are treated fairly irrespective of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, sexual orientation, or any other protected grounds, in accordance with the Equality Act. To help us monitor the effectiveness of our Equality and Diversity Policy you are asked to complete this form. The information you provide on this form will be treated in the strictest confidence and will be used for monitoring purposes only.

Ethnic origin

Please indicate which group best describes your ethnic origin by ticking the relevant box. Please note that this question does not require any information relating to nationality, place of birth or citizenship. UK citizens can belong to any of the ethnic categories indicated.

a)White

White British – you may also tick one of the four boxes below if you wish

English

Scottish

Welsh

Northern Irish

Irish

Gypsy or Irish Traveller

Any other white background - Please specify: ______

b)Mixed/multiple ethnic groups

White and Black Caribbean

White and Asian

White and Black African

Any other mixed background -Please specify: ______

c)Asian/Asian British

Indian

Pakistani

Bangladeshi

Chinese

Any other Asian background - Please specify: ______

d)Black/African/Caribbean/Black British

African

Caribbean

Any other Black background - Please specify: ______

e)Other ethnic group

Arab

Any other ethnic group - Please specify: ______

Prefer not to answer

Please indicate which of the following age groups applies to you:

18-24 years

25-34 years

35-44 years

45-54 years

55-64 years

65 years or over

Prefer not to answer

What is your religion?

a)Christian 

b)Buddhist 

c)Hindu

d)Jewish

e)Muslim 

f)Sikh

g)Any other religion

h)No religion 

i)Prefer not to answer

What is your sexual orientation?

a)Homosexual 

b)Heterosexual 

c)Bisexual

d)Prefer not to answer

What is your gender? Male Female Prefer not to answer

Are you married or in a civil partnership? Yes No Prefer not to answer

Disability

Many people do not consider themselves to be disabled, but under the Equality Act you can consider yourself disabled if you have a physical or mental impairment or long-term health condition, andthe effects are expected to last, or have lasted for a year or longer, and have a substantial effect on your ability to carry out day-to-day activities, or your day-to-day activities would be limited without medication, treatment or adjustments (for example the use of inhalers, physiotherapy, a hearing or visual aid, or insulin). Taking this into account, do you consider yourself to be a disabled person?

 Yes No Prefer not to answer

Thank you for completing this form. The information it contains will be held confidentially, and will not form part of any selection process. It will be used only for the purpose of monitoring our adherence to our Equality and Diversity Policy.

This form has been created with reference to the ethnic origin classifications used in the 2011 Census.