Equality and Diversity Monitoring Form
Eczema Outreach Support wants to meet the aims and commitments set out in our equality policy. This includes not discriminating under the Equality Act 2010, and building an accurate picture of the make-up of the workforce in encouraging equality and diversity.
Filling in this form is voluntary and will not be connected to your application in any way, but we really appreciate your help and co-operation in enabling us to gather this important data.
After answering the questions please just press submit at the end.
Which job are you applying for?
Where did you see the job advertised
Gender
Man
Woman
Intersex
Non-binary
Prefer not to say
I have a different preferred term
If you prefer too use your own term please specify:
Are you married or in a civil partnership?
Yes
No
Prefer not to say
Age
16-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Prefer not to say
What is your ethnicity?
Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box
White
English
Welsh
Scottish
Northern Irish
Irish
British
Gypsy or Irish Traveller
Prefer not to say
Any other white background, please write in
Mixed/Multiple Ethnic Groups
White and Black Caribbean
White and Black African
White and Asian
Prefer not to say
Any other mixed background, please write in
Asian/Asian British
Indian
Pakistani
Bangladeshi
Chinese
Prefer not to say
Any other Asian background, please write in
Black/African/Caribbean/Black British
African
Caribbean
Prefer not to say
Any other Black/African/Caribbean background, please write in
Other ethnic group
Arab
Prefer not to say
Any other ethnic group, please write in
Do you consider yourself to have a disability or health condition?
Yes
No
Prefer not to say
What is the effect or impact of your disability or health condition on your ability to give your best at work (
The information in this form is for monitoring purposes only. If you believe you need 'reasonable adjustment' then please discuss this with the manager running the recruitment process
)
What is your sexual orientation?
Heterosexual
Gay
Lesbian
Bisexual
Prefer not to say
If you prefer to use your own term please specify
What is your religion or belief?
No religion or belief
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
Prefer not to say
If other religion or belief, please write in
If other please write in
Do you have caring responsibilities?
if yes, please tick all that apply
None
Primary carer of a child/children (under 18)
Primary carer of a disabled child/children
Primary carer of a disabled adult (18 and over)
Primary carer of an older person
Secondary carer (another person carries out the main caring role)
Prefer not to say
Contact Information