Applicant monitoring questionnaire

MSSC is committed to equality in the conduct of its recruitment and selection procedures. It is MSSC policy to treat job applicants and employees in the same way irrespective of race, ethnicity, gender, sexual orientation, marital status, age, disability, chronic illness, religion or beliefs.

Our equal opportunities policy has been developed to ensure that MSSC applicants and staff are fully aware of our commitment to provide equality of opportunity in the recruitment and selection procedure. Furthermore, MSSC will monitor the implementation and application of this policy.

Applicants are requested to complete this questionnaire to help MSSC to monitor its equal opportunity policy and in improving our practices. We recognise that some people may consider some of this information as personal and we have included an option in most questions for ‘prefer not to say’. You do not have to complete all of this form but it will help us if you can complete as much as possible and return the form to . No information that you provide us within this form will be used in the short listing process for our vacancies and it will not be used for any other purpose than for diversity monitoring. Many thanks.

Post applied for (job title):

Full name:

Where did you see the post advertised?

Date form completed?

1. My gender is:

Male / Female / Transgender / Prefer not to say

For the purpose of this question ‘transgender’ is defined as an individual who lives, or wants to live, in the gender opposite to the one they were assigned at birth.

2. My age is:18-25 26-35 36-45 46-55 56-65 66+ Prefer not to say

3. What is your ethnic origin?

A. Asian/Asian British
Bangladeshi
Indian
Pakistani
Chinese
Any other Asian background
Insert here:______
B. Black/African/Caribbean/Black British
African
Caribbean
Any other Black background
Insert here:______
C. White
English/Welsh/Scottish/Northern Irish/
British
Irish
Gypsy or Irish Traveller
Any other White background
Insert here:______
/ D.Mixed
White and Asian
White and Black African
White and Black Caribbean
Any other Mixed background
Insert here:______
/
E.Other ethnic group
Arab
Any other ethnic background
(specify here if you wish)
Insert here:______/
/ F. Other
Prefer not to say

4. Religion - I would describe myself as being of the following religion (or belief)

Buddhism / Judaism / Other (please specify below)
Christianity / Islam / Sikhism
Hinduism / No religion / Prefer not to say

5. Sexual orientation - I would describe myself as:

Bi-sexual / Heterosexual/straight / Gay man
Gay woman / Other (specify if you wish) / Prefer not to say

6. Do you consider yourself to have a disability according to the terms given below?

Yes / No / Prefer not to say

The Equality Act 2010 protects disabled people. It says that a person has a disability if they have a physical or mental impairment which has a substantial and long-term adverse affect on their ability to carry out normal day-to-day activities. This would include things like using a telephone, reading a book or using public transport

If you have answered yes, please indicate the type of impairment which applies to you below.
Would you need any adjustments to be made to carry out this role?
Do you need any special assistance in attending interview? If so, please give details:
People may experience more than one type of impairment, in which case please mark all the types that apply.
If your disability does not fit any of these types, please mark Other.
Physical impairment, such as difficulty using your arms or mobility issues which mean using a wheelchair or crutches
Sensory impairment, such as being blind/having a serious visual impairment or being deaf/having a serious hearing impairment
Mental health conditions, such as depression or schizophrenia
Learning disability (such as Down’s syndrome or dyslexia) or cognitive impairment (such as autism or head injury)
Long-standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy
Prefer not to say
Other, such as disfigurement
(specify here if you wish)

Any application form being submitted must be accompanied by a completed Applicant Monitoring Questionnaire for monitoring purposes.