Equality Monitoring Form Equality Monitoring Form PRIVATE & CONFIDENTIALHiddenReference (Office Only) Post applied for I consider myself to be:* Male Female I am aged:* Community background:* Protestant Catholic Neither Please specify:* DIVERSITY Diversity questions are not about nationality, place of birth or citizenship. They are about broad ethnic groupings. For example, UK and Irish citizens can belong to any of the groups indicated. I would describe my ethnic or cultural origin as:* Black/African/Caribbean Chinese Indian Pakistani Traveller White Other Asian Other Other (please describe) DISABLILTY The Disability Discrimination Act (1995) describes a disabled person as someone with a ‘physical or mental impairment, which has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities’. Do you consider yourself to have a disability?* Yes No Are you registered disabled?* Yes No what is the nature of your disability? ADDITIONAL INFOWhere did you see the advertisement or how did you hear about this post?* PhoneThis field is for validation purposes and should be left unchanged.