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EQUAL EMPLOYMENT OPPORTUNITIES MONITORING FORM
Blue Smile is working towards equal opportunities to ensure that the way we deliver services, employment and volunteer placements is fair and just for everyone. We endeavour to treat all people equally and fairly.
Our equal opportunities policy aims to ensure that no individual receives less favourable treatment on the grounds of gender, race, religion, nationality, disability, age, marital status, sexual preference, responsibility for dependants, or any conditions or requirements that cannot be shown to be justified.
Please complete this form to assist Blue Smile in monitoring its recruitment and selection process. All information will be treated in confidence and will not be seen by staff directly involved in the appointment. (The questionnaire will be detached from your application form, stored separately and used only to provide statistics for monitoring purposes.) In addition, the information will form part of the employment record for the successful applicant and will be used by Blue Smile for later equal opportunities monitoring purposes throughout the period of employment.
Post title:Location:
Full name:
1. Gender (delete as appropriate):
MALE / FEMALE
2. Age
3. Marital status (delete as appropriate and please specify if other):
MARRIED / NOT MARRIED/ OTHER
4. Do you have responsibility for dependants? (Delete as appropriate. Dependants relates to children or elderly or other persons for whom you are the main carer.)
YES / NO
5. Do you have any disabilities or medical conditions? (delete as appropriate):
YES / NO
6. Ethnic origin (Relates to a sense of identity/belonging on the basis of race/culture).
I would describe myself as:
(Choose ONE section from A to E for your ethnic origin. Then complete the appropriate box using ü or YES to indicate your cultural background.)
A White:
British
English
Scottish
Welsh
Irish
Northern Irish
Other, please specify:
B Mixed:
White and Black Caribbean
White and Black African
White and Asian
Other, please specify:
C Asian, Asian British, Asian English, Asian Scottish or Asian Welsh:
Indian
Pakistani
Bangladeshi
Other, please specify:
D Black, Black British, Black English, Black Scottish, or Black Welsh:
Caribbean
African
Other, please specify:
E Chinese, Chinese British, Chinese English, Chinese Scottish, Chinese Welsh, or other ethnic group:
Chinese
Other, please specify:
F Other ethnic group:
Arab
Other, please specify:
7. Where did you see this post advertised?
8. Signature
I give consent to Blue Smile processing the data supplied in this form for the purpose of recruitment and selection.
Applicant's signature (please type if applying electronically):
Applicant's name / Date: