Equal Opportunities Monitoring FormCompletion of this form is required to proceed to the next stage of recruitment Reference Number 1. Sex * Male Female 2. Age Range * Under 18 18-25 26-40 41-50 51-60 61-70 70+ 3. community Background * I am a member of the Protestant Community I am a member of the Roman Catholic Community I am a member of neither the Protestant or Roman Catholic Community 4. Disability * The definition of a disability in the Disability Discrimination Act 1995 is: A physical or mental impairment which has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities. Do you meet (or have you, in the past, met) this definition? Yes No Mobility Vision Hearing Speech Mental Learning Dexterity/Co-ordination Other 5. Racial/ethnic Origin * White Chinese Irish Traveller Indian Pakistani Bangladeshi Black African Black Caribbean Black other (please specify) Mixed ethnic group or other (please specify) 6. Nationality Click 'Send' to Submit your Monitoring Form Thank you!
