Millwall Football Club Academy Diversity Monitoring Form The completion of this form is voluntary and any information provided will stay confidential, and be stored securely and limited to staff within the Human Resources Team. Question Title * Marital status Single (Never married) Married Separated Divorced Widowed Other (please specify) Question Title * Number of Dependents I have responsibility for one or more dependents I do not have responsibility for one or more dependents I do not wish to say EthnicityWhich ethnic group do you most identify with? Question Title * Asian Asian-British, Asian-English, Asian-Scottish, or Asian-Welsh Bangladeshi Indian Pakistani Any other Asian background (please specify) Question Title * Black Black-British, Black-English, Black-Scottish, or Black-Welsh African Caribbean Any other Black background (please specify) Question Title * Chinese Chinese British, Chinese English, Chinese Scottish, or Chinese Welsh, or other ethnic group Chinese Any other ethnic background (please specify) Question Title * Mixed White and Asian White and Black African White and Black Caribbean White and Chinese Any other Mixed background (please specify) Question Title * White British English Irish Scottish Welsh Any other White background (please specify) Question Title * Your religion or beliefWhich group below do you most identify with? No religion Baha'i Buddhist Catholic Christian Hindu Jewish Muslim Sikh Any other religion or belief (specify if you wish) Question Title * DisabilityThe Equality Act 2010 defines a person as disabled if they have a physical or mental impairment, which has a substantial and long term and has an adverse effect on the person’s ability to carry out normal day-to-day activities.Do you consider yourself to have a disability according to the terms given in the Equality Act? Yes No Prefer not to say If you have confirmed that you consider yourself to have a disability according to the terms given in the Equality Act, please communicate this to the HR and Payroll Officer on receipt of your offer for an interview. Millwall Football Club Academy will ensure that any reasonable adjustments will be implemented to support you in your interview. Question Title * Your gender Male Female Prefer not to say It is unlawful to discriminate on the grounds of transsexual identity, i.e. against someone who intends to undergo, is undergoing, or has already undergone gender reassignment. Question Title * Do you identify yourself as transsexual according to the definition above? Yes No Prefer not to say Question Title * Your sexual orientation Bisexual Gay man Gay woman / lesbian Heterosexual /straight Other (please specify) Done