DRAKE MUSIC SCOTLAND

Equal Opportunities Monitoring Form

In order to check the effectiveness of our equal opportunities policy, we monitor a range of areas where people may experience discrimination. Please help us by completing this form and returning it with your application. The information will not be made available to people involved in the selection process and will be used for monitoring purposes only. It will not affect your application adversely if you choose not to fill in and return this form.

DETAILS OF THE JOB YOU ARE APPLYING FOR

Job Title

Please CirclePart-time / Full-timePermanent / Temporary

1. What is your gender?Male / Female

2. Do you have regular caring responsibilities for dependents?Yes / No

If yes, do you care for: children / other dependents (e.g. elderly or disabled) / both

3. Are you married / currently living with a partner / single / widowed / civil partnership

4. What is your date of birth?

5. The Disability Discrimination Act 1995 defines disability as a physical or mental impairment which has a substantial and long-term adverse effect on a person’s ability to carry out normal day to day activities.

Do you consider that you have a disability?Yes / No

If yes, please state the nature of the disability:

6. Ethnic origin is about colour and broad ethnic and cultural grouping. Different groups may face different experiences of discrimination. The categories reflect current guidelines from the Commission for Racial Equality.

Do you define yourself as ‘white’?Yes / No

What are your ethnic origins?

Mixed ethnic origins (please specify)

Irish

African

Bangladeshi

Caribbean

Chinese

Indian

Pakistani

Other (please specify)

If you usually describe yourself in a different way from the categories shown above, please also provide this information:

7. Whilst religion is not covered specifically by legislation it is an area where discrimination can often occur.

Do you have a religion?Yes / No

If yes, what is your religion? Please specify:

8. Please say how you heard about this job.

Advertisement (please say where)

By word of mouth

Through an organisation (say which)

Other (please give details)

PERMISSION

All information will be treated in the strictest confidence and separated from the application form. By returning the completed form, I give permission for the details from this monitoring form to be held on computer.

Signed

Date

Thank you for your help in filling this form.