Equal Opportunities Monitoring Form

2016

1. How would you describe your ethnic origin?

White
Scottish
Other British
Irish
Gypsy/Traveller
Polish
Other white ethnic group, please
describe:
Asian, Asian Scottish or Asian
British
Pakistani, Pakistani Scottish or
Pakistani British
Indian, Indian Scottish or Indian
British
Bangladeshi, Bangladeshi Scottish
or Bangladeshi British
Chinese, Chinese Scottish or
Chinese British
Other, please describe:
2. What is your gender?:
Male
Female
Other
Prefer not to say

African
African, African Scottish
or African British
Other, please describe:
Caribbean or Black
Caribbean, Caribbean
Scottish or Caribbean
British
Black, Black Scottish or
Black British
Other, please describe:
Other ethnic group
Arab, Arab Scottish or
Arab British
Other, please describe:
Mixed or multiple
ethnic group
Any mixed or multiple
ethnic groups, please
describe:

3. Do you consider yourself disabled?:

Yes
No

4. Are you registered disabled?:

Yes
No

5. What is your age?:

18-24
25-34
35-44
45-54
55-64
64 or older

6. How did you hear about this opportunity?:

7. Role applied for:
Please note: in line with the Data Protection Act, all sensitive and personal information will be confidential and your
contact details will not be passed on to any third parties.