Equal opportunities monitoring form – CONFIDENTIAL
Y Care International is committed to the active promotion of equal opportunity, both in the provision of services and as an employer of paid workers, volunteers and trustees. Please read our Equal Opportunities and Diversity Policy, below.
To help us monitor our equal opportunity policy in recruitment and selection procedures, you are requested to complete the monitoring form below.
Cooperation in completing this form is greatly appreciated. Any information you give will be strictly confidential. You do not have to answer any of the questions but we would like to achieve 100% response. Not answering any question(s) will not affect your application in any way.
Post applied for:Title:
Full name:
Personal email:
National Insurance number
1. Gender
Male / Other
Female / Prefer not to say
2. Date of birth (dd/mm/yy):
3. Marital status:
Co-habiting / Separated
Divorced / Single
Married / Widowed
Partner / Prefer not to say
4. Do you have responsibility for dependants? (Dependants relates to children, or elderly or other persons for whom you are the main carer.)
Yes / No
If yes, how many dependants are you responsible for?:
5. Do you have any disabilities?
Yes / No
6. Ethnic origin
White British / Asian or Asian British – Indian / Mixed Ethnicity – White and Black Caribbean
White Irish / Asian or Asian British – Pakistani / Mixed Ethnicity – White and Black African
Black or Black British – Caribbean / Asian or Asian British – Bangladeshi / Mixed Ethnicity – White and Asian
Black or Black British – African / Asian or Asian British – Chinese / Prefer not to say
Any other Ethnic origin (please specify):
7. Nationality (please specify)
8. Religion
Christian / Jewish
Muslim / Buddhist
Hindu / No religion
Sikh / Prefer not to say
Any other religion (please specify):
9. Where did you see this post advertised?
Y Care International website
CharityJob website
BOND website
Other (please specify):