YoungMinds Equal Opportunities Monitoring Form

Thank you for your interest in YoungMinds. Please do not write your name on this form. Any information you provide is confidential, does not form part of the application process and will be removed from your application form prior to the shortlisting process. The categories below reflect the protected characteristics in the Equality Act 2010.

Completing this form is voluntary, however, the information collected would allow us to monitor our workforce and ensure that we continue to be an inclusive employer. YoungMinds is committed to equal opportunities and has a policy that is supported by our Code of Practice.

Please state which post you are applying for

Where did you find out about this post?
Gender (please tick)
Male / Female / Gender Non-Binary / Prefer not to say
Is your gender identity the same gender you were assigned at birth?
Yes / No / Prefer not to say
Your Age (please tick)
16-24 / 25-34 / 35-44 / 45-54 / 55-64 / 65+
Date of Birth:

Marital Status

Please indicate your marital status
Cohabiting / Divorced / In a civil partnership / Married / Separated
Single / Widowed/surviving partner / Other (please specify) / Prefer not to
say
Disability / 
Do you have a disability or impairment? This includes a physical or mental health condition, which has lasted or is expected to last at least 12 months, which has an adverse effect on your ability to carry out normal day-today activities? (please tick) / Yes / No / Prefer not to say
YoungMinds is committed to making reasonable adjustments to enable all staff to contribute fully to the work of YoungMinds. Please provide details here of any reasonable adjustments you may require during the selection process, or to your job or working arrangements if appointed. A member of the HR team will contact you in confidence to discuss any adjustments you identify.

Sexual Orientation

Please indicate how you would prefer to describe your sexual orientation /

Bisexual / Gay Man / Heterosexual / Lesbian/
Gay Woman / Other / Prefer not to say

Ethnic Origin

Please indicate how you would prefer to describe your ethnic origin by ticking the appropriate sub-category.

CATEGORY / SUB-CATEGORY
Asian/
Asian British / Asian British / Indian / Bangladeshi
Pakistani / Chinese / Japanese
Any other Asian Background (please specify)
Prefer not to say
Black/
Black British / Black British / African / Caribbean
Any other Black Background (please specify)
Prefer not to say
Mixed Heritage / White and Black African / White and Black Caribbean / White and Asian
Black African and Asian / Black Caribbean and Asian / Prefer not to say
Any other Mixed Background (please specify)
White / White British / White Irish / White European
Prefer not to say
Any other White Background (please specify)
Other / Any other ethnic group (please specify)
Prefer not to say
Religion or belief
How would you describe your religion?
Buddhist / Christian
(including all Christian denominations) / Hindu
Jewish / Muslim / Sikh
None / Prefer not to say / Any other religious belief (please specify)

By completing this form I understand that I give my consent under the Data Protection Act 1998 for the information contained in this form to be processed in accordance with the YoungMinds policy for the purposes of equal opportunities monitoring.