YSI Equal Opportunity Monitoring Survey (2019)

The information on this form will be treated in confidence and used solely by the HR Department for the purpose of providing statistics for equal opportunities monitoring. This form does not form part of your application and will be detached from it on receipt and stored separately.

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* 1. Full Name

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* 2. Job Applying for

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* 3. Gender

Male

Female

Prefer not to say

Other (please specify)

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* 4. Age

18-25

26-25

36-45

46-55

56-65

65+

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* 5. What do your define your ethinicity as (feel free to select as many as you wish)

White English / Welsh / Scottish / Northern Irish / British

White Irish

White Gypsy or Irish Traveller

Any other White background, please describe

Mixed / Multiple ethnic groups

White and Black Caribbean

White and Black African

White and Asian

Any other Mixed / Multiple ethnic background, please describe

Asian / Asian British

Indian / British Indian

Pakistani / British Pakistani

Bangladeshi / British Bangladeshi

Chinese / British Chinese

Any other Asian background, please describe

Black / African / Caribbean / Black British

African / British African

Caribbean / British Caribbean

Any other Black / African / Caribbean background, please describe

Arab / Arab British

Any other ethnic group, please describe

Please describe:

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* 6. Religion

Christian

Hindu

Jewish

Buddhist

Sikh

Muslim

No religion

Prefer not to say

Other (please specify)

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* 7. Disabilities

None

Physical disabilities, please describe

Mental disability, please describe

Prefer not to say

Please describe: