Headway Cardiff & South East Wales is committed to recruiting, retaining and developing a workforce that reflects at all grades the diverse communities that we serve. It is vital that we monitor and analyse diversity information so that we can ensure that our HR processes are fair, transparent, promote equality of opportunity for all staff and do not have an adverse impact on any particular group. 

Your cooperation in providing us with accurate data will ensure that we not only meet our legal obligations but even more importantly, will result in us designing and applying policies and processes that attract and retain a diverse, talented and motivated workforce. 

Any information provided on this form will be treated as strictly confidential, will be used for statistical reporting purposes only and will comply with data protection rules. 

* 1. Position applied for:

* 2. Age:

* 3. Disability
Under the Equality Act 2010, a person is considered to have a
disability if she/he has a physical or mental impairment which
has a substantial and long-term adverse effect on her/his ability to carry out normal day-to-day activities. In order for us to
identify and respond to your specific needs, it is important that we know what kind of disability you have. 

Do you have any of the following conditions which have lasted
or are expected to last for at least 12 months? 

* 4. Please give details of any specific interview requirements/adjustments that need to be considered: 

* 6. Gender
Please tick the box that best describes you 

* 7. Religion
Please tick as appropriate

* 8. Sexual Orientation
Please tick the box that best describes your sexual orientation

* 9. Marriage and Civil Partnership
Please tick one box

* 10. Language
Please provide details of your first language

* 11. Welsh Language
Please specify your abilities in relation to Welsh language

  None Some Fluent
Thank you for completing this form. 

Please be assured that this monitoring form will be separated prior to any selection exercise. 

If you have any queries in relation to this form, please contact us on
02920 577707
or email