MASTER Equal Opportunity Monitoring Form Template

Equality Opportunities Monitoring Form
Policy
Anderson Quigley believes that there should be no discrimination because of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, sexual orientation. Anderson Quigley operates an equal opportunity policy and commits to following all obligations under the Equality Act. Anderson Quigley will take appropriate steps to ensure that all applicants are reviewed on the basis of ability and the requirements of the promoted role.
Monitoring
To ensure that the equal opportunities policy is effective, monitoring of applications will be carried out. This necessitates the collection of information regarding the applicant’s ethnic origin, sex, gender identity, marital status, disability, religion, belief, and sexual orientation. This monitoring form may also be shared with [client name] for their own equality monitoring purposes.
All information will be treated as strictly confidential and in accordance with the General Data Protection Regulation (EU) 2016/679 and national laws such as the Data Protection Act 2018 as amended, re-enacted or consolidated from time to time. Please tick the following box to provide Anderson Quigley with your express consent to use and share this data with [client name] as described above.*
Express consent given
Name
First NameLast Name
Sex, Gender Identity and Date of Birth
Gender
MaleFemalePrefer not to answer
Is your gender the same as the gender you were assigned at birth?
YesNoPrefer not to answer
Date of Birth
MonthDayYear
Please leave blank if you prefer not to answer
Age
16–2425–2930–3435–3940–4445–4950–5455–5960–6465+Prefer not to answer
Marital Status
MarriedCivil PartnershipDivorcedSingleCo-habitingSeparatedWidowedPrefer not to answerOther
Ethnicity
The following categories have been devised by the UK governments Census of population and are recommended by the Equality and Human Rights Commission. It is important to understand that these questions are not about nationality, place of birth or citizenship.
White
EnglishWelshScottishNorthern IrishIrishBritishGypsy or Irish TravellerPrefer not to answerOther
Mixed/Multiple ethnic groups
White and Black CaribbeanWhite and Black AfricanWhite and AsianPrefer not to answerOther
Asian/Asian British
IndianPakistaniBangladeshiChineseArabPrefer not to answerOther
Black/African/Caribbean/Black British
AfricanCaribbeanPrefer not to answerOther
My Nationality is:
Please leave blank if you prefer not to answer.
What is your sexual orientation?
HeterosexualGay woman/lesbianGay manBisexualPrefer not to answerOther
What is your religion or belief?
No religion or beliefBuddhistChristianHinduJewishMuslimSikhPrefer not to answerOther
Do you have a disability? Please state if you have any long-term physical or mental condition that affects your ability to carry out day-to-day activities?
NoYes, please select from the option(s) belowPrefer not to answer
Two or more impairments and/or disabling medical conditionsSpecific learning disability (such as dyslexia or dyspraxia)General learning disability (such as Cerebral Palsy orDown’s Syndrome)Social/communication impairment such as Asperger’s or other autistic spectrum disorderLong-standing illness or health condition e.g.cancer, diabetes, chronic heart disease, epilepsy)Mental health condition such as depression, anxiety or bipolarPhysical impairment or mobility issues such as difficulty using arms or using a wheelchair or crutchesDeaf or serious hearing impairmentBlind or serious visual impairment uncorrected by glassesOther type of disability, impairment or medical conditionPrefer not to answer
There are 9 categories in the relevant legislation which are used to assess whether an individual’s condition is likely to be deemed a disability and applicants may wish to declare any conditions. Please describe any special needs so that any arrangements and reasonable adjustments necessary for an interview can be made in the box below.
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Equality Opportunities Monitoring Form

Sex, Gender Identity and Date of Birth

Ethnicity

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