Equality, Diversity and Inclusion monitoring form

The Welcome Centre wants to meet the aims and commitments set out in its 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.

The information provided by you will be used for statistical purposes only to ensure that our recruitment processes uphold our commitment to equality and diversity.

We need your help and co-operation to enable us to do this, but filling in this form is entirely voluntary and you do not have to complete it. If there are certain sections of the form you don’t want to complete, please highlight the relevant ‘prefer not to say’ box.

Completing this form

Our Equality, Diversity and Inclusion form is optional.

If you are happy to complete it, please fill in the questions below either using your own words or using the relevant tick box.

Equality and diversity monitoring form

Please confirm your gender using your own terms or leave blank if you prefer not to say (optional)

Is the gender you identify with the same as your gender registered at birth?

Yes

No

Prefer not to say

Please choose your chosen pronoun

He/him

She/her

They/them

Prefer not to say

Pronouns - if you use your own pronouns not included above please write below (optional)

Marital stauts

Single

Married/Civil partnership

Divorced

Widowed

Living with partner

Prefer not to say

What is your ethnicity? Ethnic origin is not about your nationality, place of birth or citizenship, it is about the group to which you perceive you belong. Please write below or leave blank if you prefer not to say. (optional)

Do you consider yourself to have a disability or health condition?

Yes

No

Prefer not so say

If you answered Yes to the above, are there any reasonable adjustments we can make to ensure you can comfortably fulfil your duties? (optional)

What is your religion or belief? Please write using your own terms or leave blank if you prefer not to say. (optional)

What is your sexual orientation? Please write using your own terms or leave blank if you prefer not to say. (optional)

Do you have caring responsibilities? If yes, please tick all that apply

Primary carer of a child/children under 18

Primary carer of a disabled child/children under 18

Primary carer of a disabled adult 18 and over

Secondary carer (another person carries out the main caring role)

Prefer not to say

Thank you for completing this form. You can leave any further comments below. (optional)

If you are a human, ignore this field