CONFIDENTIAL APPLICATION FORM 
SECTION 3

Diversity monitoring

Please note this section will be detached before sending your application to the recruitment panel for shortlisting.	

Job title:	 	
Candidate ref. number (for office use only):	 	

The Citizens Advice service is committed to valuing diversity and promoting equality. We encourage and welcome applications from suitably qualified candidates from all backgrounds regardless of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex or sexual orientation.

In order to achieve these aims we need to know about the diversity of people who apply to work in the service. Please help us by providing the information requested in the form below

Data protection overview

If you are happy to provide it, we will use this information for the sole purpose of allowing us to monitor equality of opportunity and treatment as necessary to maintain or promote equality within Citizens Advice ****.

The information you give us will be kept securely, won't be shared outside the service and is confidential.

It will not be seen by anyone responsible for making recruitment decisions or have any impact on you directly. 

If you are successful in your application and we require this information for other purposes, you will be asked to provide it separately - i.e. this form will not be used for other purposes.  

If you would prefer not to answer any of the questions we ask, please leave them blank. If you would like us stop using the information you provide, please contact us.

Thank you for your co-operation.

The following information will not be seen by the recruitment panel and will not affect your application.	

Age
Which age bracket do you fit into? Put a cross in the relevant box.

Under 25			
25 - 34		
35 - 44		
45 - 54			
55 - 64		
65 and over		

Gender
What best describes your gender? Put a cross in the relevant box or write in a preferred term.
    
Female		
Male		
I prefer to use another term

Please write in……………………………………...		

Sexual orientation
What is your sexual orientation? Put a cross in the relevant box or write in a preferred term.

Heterosexual/Straight		
Gay Man		
Gay Woman/Lesbian		
Bisexual		
I prefer to use another term

Please write in……………………………………….	

	 

Ethnic origin
How would you describe yourself? Choose one section (A to E) and put a cross in the relevant box within it.

A.  White	English/Welsh/Scottish/Northern Irish/British		
	Irish		
	Gypsy or Irish Traveller		
	Any other White background

Please write in……………………………………….		
B.  Mixed/multiple ethnic groups	White & Black Caribbean		
	White & Black African		
	White & Asian		
	Any other Mixed/multiple ethnic background

Please write in……………………………………….	

C.  Asian/Asian British	Indian		
	Pakistani		
	Bangladeshi		
	Chinese		
	Any other Asian Background

Please write in……………………………………….		
D. Black/African/ Caribbean/Black British	African		
	Caribbean		
	Other Black/African/Caribbean background

Please write in……………………………………….		
E. Other ethnic group	Arab		
	Any other ethnic group

Please write in……………………………………….		

Disability 
A disabled person is defined under the Equality Act 2010 as someone with a ‘physical or mental impairment which has a substantial and long term adverse effect on that person’s ability to carry out normal day-to-day activities.’

Do you consider yourself to be disabled under the Equality Act 2010?

Yes		
No		

The information on this form is for monitoring purposes only. If you require any reasonable adjustments to be made in the recruitment process or at work subsequently if appointed, please make sure you tell us separately from this form. We follow the social model of disability which believes that it is the barriers created by society which disable people. We will use reasonable adjustments wherever possible to remove those barriers. 

Gender Identity
Is your gender identity the same as the gender you were assigned at birth? Put a cross in the relevant box.

Yes		
No		

Religion or belief
Which group below do you most identify with? Put a cross in the relevant box.

No religion		
Christian (including all denominations)		
Buddhist		
Hindu		
Jewish		
Muslim 		
Sikh		
Any other religion or belief

Please write in……………………………………….	

How did you hear about this opportunity?

Please include details below: