Equal Opportunities Online Form

Larbey Evans operates an equal opportunity policy. To help us monitor the effectiveness of this policy you are requested to complete this form and return it with your application form. A statement of our equal opportunity policy is included in the recruitment pack. This monitoring form will be detached from your application form and will be kept separately from the information to be used in the selection process.

[* Certain details are necessary for the monitoring process to be effective but it is not generally considered necessary or desirable to request the name of an individual if the process is to be seen to be purely for the purposes of monitoring your equal opportunities policy.]

Name*

First Last

Reference Number

Position applied for

Ethnic Category*

The following categories are based on those used in the 2011 census as recommended by the EHRC. Please note the ethnic questions are not about nationality, place of birth or citizenship. UK citizens can belong to any of the ethnic categories indicated. How would you describe your national identity? (Please tick a box below)

Please tick the box below which best describes the ethnic category to which you belong:

A. White

English / Welsh / Scottish / Northern Irish / British
Irish

B. Mixed / multiple ethnic groups – please also tick one of the boxes below:

White and Black Caribbean
White and Black African
White and Asian

C. Asian / Asian British

D. Black / African / Caribbean / Black British

African
Caribbean

E. Other ethnic group

Arab
Prefer not to disclose

Gender

Male
Female
Prefer not to disclose

Disability

Please state if you have any long-term physical or mental condition that affects your ability to carry out day-to-day activities. (Advice can be obtained from the EHRC 0845 604 6610):

Yes
No
Prefer not to disclose

Age*

DD

MM

YYYY

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