EQUAL OPPORTUNITIES MONITORING FORM Disability Equality Scotland is committed to equal opportunities to ensure that no job application receives less favorable treatment on race, religion, gender, marital status, age, disability or sexuality. Please complete this form so that we can monitor the implementation of our equal opportunities policy. The answers that you give will be treated in the strictest confidence and will only be used for statistical monitoring. This page will not be attached to the application form during the short listing and interview process. Disability / Long term condition Do you have any of the following conditions which have lasted, or are expected to last at least 12 months? Please tick all that apply Deaf, deafness, hard of hearing or deafblindness Blindness or other vision impairment A Physical Disability A Learning Disability A mental health condition A long term illness Prefer not to answer Other – Please write ????? Gender Female Male Non-binary Prefer to self-describe Prefer not to answer Age Range Under 25 25-34 35-49 50-65 Over 65 Religion None Church of Scotland Roman Catholic Other Christian Muslim Buddhist Sikh Jewish Hindu Pagan Prefer not to answer If other religion or belief, please write ????? Sexual Orientation How would you describe your sexual orientation? (please tick one box only) Straight Gay/Lesbian Bisexual Prefer not to answer If other, please write ????? Ethnic Group White English Welsh Scottish Northern Irish Irish British Gypsy or Irish Traveler Prefer not to answer Any other white background, please write ????? Mixed / multiple ethnic groups White & Black Caribbean White & Black African White & Asian Prefer not to answer Any other mixed background, please write ????? Asian or Asian British Pakistani Indian Bangladeshi Chinese Prefer not to answer Any other Asian background, please write ????? Black / African / Caribbean / Black British African Caribbean Prefer not to answer Any other Black/African/Caribbean background, please write ????? Other ethnic group Arab Prefer not to answer Any other ethnic group, please write ????? Please attach this completed form to your application and send to: Morven Brooks, Chief Executive Officer, Disability Equality Scotland morven@disabilityequality.scot Suite 204B, The Pentagon Centre, 36 Washington Street, Glasgow G3 8AZ Registered in Scotland as a Company Ltd by Guarantee with Charitable Status 0141 370 0968 | admin@disabilityequality.scot | www.disabilityequality.scot Registered Scotland Charity Number: SCO 31893 Company Number: SC 243392 Suite 204B, The Pentagon Centre, 36 Wahington Street, Glasgow G3 8AZ Registered in Scotland as a Company Ltd by Guarantee with Charitable Status 0141 370 0968 | admin@disabilityequality.scot | www.disabilityequality.scot Registered Scotland Charity Number: SCO 31893 Company Number: SC 243392