Sample equal opportunities monitoring form

[Name of organisation] believes in equal opportunities.

We want to make sure that we are an equal opportunities employer in practice, which is why we want to monitor our recruitment procedures. We will separate this part of the form from the application form. It will not form part of the selection process.

Please tick the appropriate boxes:

Gender

Male ___Female___ Prefer not to say___
If you are undergoing the process of gender reassignment, please tick the box that applies to your future gender.

What age group do you belong to?

___18-25 ___25-35 ___35-45 ___ 45-55 ___over 55 ___Prefer not to say

How would you describe your sexuality?

___heterosexual/straight ___gay man ___gay woman/lesbian ___bi-sexual ___Prefer not to say

Do you consider that you have a disability?

___Yes ___No ___Prefer not to say

Do you have a disability as defined by the Disability Discrimination Act?

___Yes ___No ___I don't know ___Prefer not to say

Do you consider that you have a long-term health problem?

___Yes ___No ___Prefer not to say

How would you describe your religion or belief?

My religion or belief is ____________________________________________