Equal Opportunities Monitoring Form
Rights of Women is an equal opportunities employer. In order to measure the effectiveness of our procedures, we would be grateful if you would complete and return this for to us.
Your answers will be treated in the strictest confidence and used only for statistical purposes. This form will not form part of the selection process. You to not have to answer any of these questions if you do not wish to.
About you
How would you describe your gender? (Please circle)
Female Male Transgender
How would you describe your ethnic origin?
White / Mixed ethnic origin / Asian / Black / Other ethnic origin British / Indian / African / Chinese
Irish / Pakistani / Caribbean / Middle Eastern
European / Bangladeshi / British
Any other white background, please write in / Please write in / Any other Asian background. please write in / Any other Black background, please write in / Any other ethnic group, please write in
Are you an asylum-seeker, refugee or woman with an insecure immigration status? (including women with possible claims for protection) (Please circle)
Yes No
Would you describe yourself as bisexual, heterosexual or lesbian? (Please circle)
Bisexual Heterosexual Lesbian
Do you consider yourself as having a disability? (Please circle)
Yes No
Is yes, how would you define your disability?
Blind Visual impairment / Deaf or hearing impairmentPhysical disability or mobility / Learning disability
Chronic illness (cancer, HIV, diabetes, heart disease, epilepsy) / Mental health
Other, please write in:
How would you describe your religion or belief? (Please circle)
Agnostic / AtheistBaha’i / Buddhist
Christian / Hindu
Humanist / Jain
Jewish / Muslim
Rastafarian / Sikh
Zoroastrian / None
Other- please write in
What is your age? (Please circle)
Under 18 / 18-2425-34 / 35-44
45-54 / 55-64
65+
Thank you for your assistance