JPF Staff Diversity Monitoring Form

Jack Petchey Foundation is committed to equal opportunities and to eliminating conscious or unconscious bias in and through our work. The questions set out in this form help us to establish if there are different success rates between people based on gender, age, ethnicity, sexuality, faith or disability and, if so, enable us to take action to address this. Your answers will be treated confidentially, will not be seen by the shortlisting panel and will not affect your application in any way.

The Jack Petchey Foundation will always keep your personal information private and hold it securely. We are committed to being open and honest, to acting with integrity and to complying with the spirit, as well as the letter, of data protection law. Our Privacy Policy is available on our website and sets out how we collect, process and store personal data, and how you can let us know if you want us to change the way we store and use your personal data. Please note that we will keep your job applications on file for up to 12 months for unsuccessful applicants and for longer for applicants who become employees.

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* 1. Vacancy Title

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* 2. What is your Gender?

Male (including trans male)

Female (including trans female)

Non binary

Other

If Other, please specify if you wish

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* 3. Is your Gender Identity the same as assigned to you at birth?

Yes

Prefer not to say

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* 4. What is your Age?

16-19

20-29

30-39

40-49

50-59

60+

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* 5. What is your Ethnicity?

Asian or Asian British - Bangladeshi

Asian or Asian British - Indian

Asian or Asian British - Pakistani

Any other Asian background

Black or Black British - African

Black or Black British - Caribbean

Black or Black British - Any other Black background

Chinese

Mixed - Black and White Caribbean

Mixed - Black and White African

Mixed - Asian and White

Mixed - Any other mixed background

White - British

White - Irish

Any other White background

Other ethnic group

Prefer not to say

If Other, please specify if you wish

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* 6. Disability

Do you consider yourself to have a disability or impairment that has (or would have without treatment) a long term adverse effect on your ability to carry out one or more day to day activities?

Yes

Prefer not to say

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* 7. If you have a disabiiity, please indicate the nature of your disability

Mobility/Manual Dexterity

Visual Impairment

Hearing Impairment

Mental Health / Cognitive Impairment

Dyslexia

Other

I do not have a disability

If Other, please specify if you wish, giving further information

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* 8. If you have a Disability, please advise of any reasonable adjustments you require for the purposes of the recruitment exercise:

I do not have a disability

If you have a Disability, please advise below of any reasonable adjustments you require for the purposes of the recruitment exercise. (Please re-confirm these details via email only if invited for interview)

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* 9. Please indicate your Religion or Belief

Atheist

Buddhist

Christian

Hindu

Judaism

Muslim

No religion

Sikh

Prefer not to say

Other

If Other, please specify if you wish

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* 10. Please indicate your Marital Status

Single

Divorced

Widowed

Married

Civil Partnership

Dissolved Civil Partnership

Prefer not to say

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* 11. Please indicate your Sexual Orientation

Bisexual

Gay Woman/Lesbian

Gay Man/Homosexual

Heterosexual/straight

Prefer not to say

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* 12. Caring Responsibilities - Do you currently have caring responsibilities?

Yes

Prefer not to say

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* 13. If you have Caring Responsibilities, please indicate the nature of your main caring responsibilities:

Child or minor dependant

Sibling/brother or sister

Partner - marriage/civil

Partner - Other

Parent

Other

I do not have caring responsibilities

If Other, please give further information

JPF Staff Diversity Monitoring Form

Question Title

* 1. Vacancy Title

Question Title

* 2. What is your Gender?

Question Title

* 3. Is your Gender Identity the same as assigned to you at birth?

Question Title

* 4. What is your Age?

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* 5. What is your Ethnicity?

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* 6. Disability Do you consider yourself to have a disability or impairment that has (or would have without treatment) a long term adverse effect on your ability to carry out one or more day to day activities?

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* 7. If you have a disabiiity, please indicate the nature of your disability

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* 8. If you have a Disability, please advise of any reasonable adjustments you require for the purposes of the recruitment exercise:

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* 9. Please indicate your Religion or Belief

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* 10. Please indicate your Marital Status

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* 11. Please indicate your Sexual Orientation

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* 12. Caring Responsibilities - Do you currently have caring responsibilities?

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* 13. If you have Caring Responsibilities, please indicate the nature of your main caring responsibilities:

* 6. Disability

Do you consider yourself to have a disability or impairment that has (or would have without treatment) a long term adverse effect on your ability to carry out one or more day to day activities?