Off the Record Equal Opportunities Form

Off the Record Equal Opportunities Form

Off the Record strives to be an equal opportunities employer in all aspects of its work. Individuals are employed regardless of race, age, ethnic origin, nationality, disability, gender, sexual orientation, religion or belief. To assist us in monitoring the effectiveness of our approach, we would be grateful if you could provide details of your gender, ethnic origin, sexual orientation n and religion. The information you provide is confidential and is not shared with any member of the interview panel.

Gender

Female □
Male □
If you prefer to use your own term please provide here:
______

Gender identity

Is your gender identity the same as the gender you were assigned at birth?

Sexual Orientation

Bisexual □
Gay Man □
Gay Woman/ Lesbian □
Heterosexual/ Straight □

Disability

Do you consider yourself to have a disability?
Yes □
No □

16 – 24 □
25 – 34 □
35 – 44 □
45 – 54 □
55 – 64 □
65+ □ /

Ethnicity:

Arab □
Asian or Asian British: Indian □
Asian or Asian British: Pakistani □
Asian or Asian British: Bangladeshi □
Asian or Asian British: Chinese □
Black or Black British: African □
Black or Black British: Caribbean □
Black or Black British: Other □
Mixed: White and Black African □
Mixed: White and Black Caribbean □
Mixed: White and Asian □
Mixed: Other □
White: British □
White: Irish □
White: Gypsy or Gypsy Traveller □
White: Other □
If another Ethnic Group or if you would prefer to use your own definition, please specify:
______

Religion and Belief

Buddhist □
Christian □
Hindu □
Jewish □
Muslim □
Non-religious (Atheist, Humanist, etc) □
Sikh □
Other □
If you prefer to use your own definition please provide here:
______

I agree that the information I have provided is accurate and truthful to the best of my knowledge.

Post applied for: ______

Where did you see this position advertised? ______

Name (please print): ______

Signature: ______Date:______