Equal Opportunities Monitoring Form

Gender Identity
Male Female Non-binary Prefer not to say

Age
Date of Birth: 18/08/1997
16 - 24 25 - 34 35 - 44 45 - 54 55 - 64
65+ Prefer not to say

Sexual Orientation
Bisexual Gay man Gay woman/lesbian
Heterosexual/straight Other (specify if you wish):
Prefer not to say

Disability
The Equality Act 2010 defines a disabled person as someone who has a physical or
mental impairment, which has a substantial and long-term adverse effect on their
ability to carry out normal day-to-day activities.

Do you consider yourself to be disabled?

Yes No
Prefer not to say

Ethnicity
These categories are based on the Census 2011 categories and recommended by
the Commission for Racial Equality.

Asian, Asian British, Asian English, White

Asian Scottish, or Asian Welsh British
Asian / Asian British English
Bangladeshi Gypsy or Irish Traveller
Chinese Irish
Indian Scottish
Pakistani Welsh
Other Asian background (specify if Other White background (specify if
you wish): you wish):

Black, Black British, Black English, Mixed

Black Scottish, or Black Welsh White and Asian
African White and Black African
Caribbean White and Black Caribbean
Other Black background (specify if White and Chinese
you wish): Other mixed background (specify if
you wish):
Other ethnic group
Arab Prefer not to say
Other ethnic group (specify if you
wish):

Privacy Notice
We are committed to equal opportunities in our recruitment and selection
processes for jobs and other training opportunities, and in order to find out how
well we are doing with this we need to collect monitoring data about the protected
characteristics of applicants. The information we collect here is very useful to us
as it helps us to make sure that we are an inclusive organisation and to find out if
we are employing a diverse range of staff, and reaching a diverse cohort of
trainees.

We may collate equal opportunities information to do high-level reporting to

funders and stakeholders. Individual data will never be identifiable in this
reporting.

The monitoring form is not sent to the selection panel and has no part in the
shortlisting process.

The information you supply on this form will be kept confidentially and securely in
accordance with our data protection policy. If you are offered a job or training
programme place, we will keep this information for the duration of your
employment/training. If you are unsuccessful we will keep this information for one
year.

This monitoring form is voluntary. By completing and submitting this form, you are
giving NYCGB explicit consent to process and use your personal data provided for
the purposes indicated above.

You have the right to request a copy of the information we hold on you; request
that information be amended, deleted or processing of it be restricted; or object to
the use of your data for certain actions. You may do so by emailing
data@nycgb.org.uk; or calling the NYCGB office on 0191 3837355.
Further information can be found at https://www.nycgb.org.uk/privacy-policy

Please complete and return this form along with the other application materials
specified on the application form to: apply@nycgb.org.uk

Thank you.