Recruitment equal opportunities survey

EQUAL OPPORTUNITIES MONITORING FORM

INTERIGHTS is comitted to a policy of Equal Opportunities in employment regardless of age, care responsibilities, ethnic origin, disability, gender, martial status, religion or sexual orientation.

The purpose of this survey is to gather information to examine the profile of our candidates as part of our efforts to be inclusive and reach diverse communities.

The information collected is confidential and will be reported anonymously and the information you give will have no bearing on the recruitment process.

Your details	Page 1 of 2
The information given below is to be used for the purpose of equal opportunities monitoring only and will not be passed on or used for any other purpose. Please respond to all questions.

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1)

Your contact details:

* First name
* Surname
* email address

*

2)

What is your gender?

Male

Female

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3)

What is your ethnic origin?

*

4)

What is your age group?

	under 18		18 - 29		30 - 39
	40 - 49		50 - 59		over 60

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5)

Do you consider yourself to have a disability? (as defined by the UK Disability Discrimination Act (DDA), 1995 (The DDA states that a person has a disability if she/he has a physical or mental impairment, which has a substantial and long-term effect on her/his ability to carry out normal day-to-day activities)

Yes

No

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6)

I have caring responsibilities at home / outside of work.

Yes

No