Equalities Monitoring Form

The information requested below will be used for the purpose of monitoring the effectiveness of our Single Equality Policy in recruitment and for that purpose only. Information provided will not be circulated to the panel or inform the selection process. 

How did you find out about this vacancy?

	

What is your gender identity?
(Male, female, other)		

Date of Birth:		

Do you have a disability as recognised under the Equality Act 2010? (Answer ‘yes’ or ‘no’ or leave blank)		

If yes, please provide details: (or leave blank)

Ethnicity monitoring: please place ‘X’ against the appropriate option.	

   White 	   Mixed or dual heritage	
   Black or British Black	   Other ethnic background 	
   Asian or British Asian	   Prefer not to disclose	
   Chinese	   Not known		

Sexuality monitoring: please place ‘X’ against the appropriate option (not compulsory)	

  Heterosexual	
  Bi-sexual		
  Gay/Lesbian	  Prefer not to say	

How would you describe your religion or belief?

My religion or belief is ____________________________________________

   I have no religion or belief

   Prefer not to say

Please return to info@qtine.com    Please do not write your name on this form.