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EQUAL OPPORTUNITIES MONITORING FORM

Erskine is committed to a policy of Equal Opportunities in employment. In order to monitor the operation of this policy, it is necessary to collect information from all applicants on key factors which relate to equal opportunity in employment i.e., ethnic origin, gender, age and disability. The information you provide on this form will be used solely for the purposes of monitoring. It will be separated from your application form and will not be made available to any members of the selection / interview panel. This information will be held and processed in accordance with the Data Protection Act. Position Applied for: Date Application Form Completed:

Date of Birth Sex Marital Status Single

Age Female Married/Couple Divorced Widowed Male Transgender

Separated (but still legally married)

Please read the list below and tick one box that most closely describes your ethnic origin. White British Mixed White and Black Caribbean
Any other mixed background. Please describe

Irish

Any other white background. Please describe

White and Black African

White and Asian

Asian or Asian British Indian

Any other asian background. Please describe

Bangladeshi

Pakistani

Black or Black British Carribean

Any other black background. Please describe

African

Chinese or ethnic group Chinese

Any other ethnic group. Please describe

If you believe you have a disability as defined by the Disability Discrimination Act, what type of disability do you have? Please tick all that apply. Blind/Partially sighted Other mobility limitation Speech difficulty Deaf/hearing impaired Wheelchair user Dyslexia or other specific Mental health difficulty learning difficulty Chronic medical condition or other unseen disability (e.g. asthma, epilepsy)

Please detail any specialised aids available to help you to work more effectively, e.g. Access, Singer, Speech Amplifier.

Religion or Belief (Please specify your religion or belief) Buddist Hindu Jewish Muslim Any other religion or belief Sexual Orientation (Do you consider yourself to be) Bisexual Hetrosexual

Christian Church of Scotland Roman catholic Other Christian (Please specify)

Homosexual (Gay/Lesbian)

Thank you for taking the time to complete this questionnaire

HR FORM 04

Please return with your application form to HR Dept. Erskine, Bishopton, PA75PU