EQUAL OPPORTUNITIES MONITORING FORM

In accordance with its equal opportunities statement, Dance City will provide equal opportunities to all employees and job applicants and will not discriminate either directly or indirectly on the grounds of race, colour, ethnic origin, nationality, national origin, sex, marital or civil partnership status, disability, sexual orientation, gender reassignment, religion or age.

In order to enable Dance City ensure compliance with its policy statement, a system of monitoring has been set up. We have only asked for your name so that monitoring can take place both at the shortlisting for interview stage and at the appointment stage. Once an appointment has been made, the data given on this form will be stored on computer in an anonymised format and the form will then be destroyed.

You may, of course, decide not to answer one or any of these questions but if you do respond, all information provided will be treated in confidence and will be used solely by the Human Resources department for the purpose of providing statistics for equal opportunities monitoring. The monitoring form does not form part of your application and will therefore be detached from it on receipt and stored separately. You can always mail this form separately if you wish.

Thank you for your assistance in completing this form.

Post title:	
Gender:	Male	
	Female	
	Prefer not to say	
Marital status:	Married	
	Single	
	In a civil partnership	
	Other (please specify)	
	Prefer not to say	
Age band:	Under 18	
	18 – 29	
	30 –39	
	40 – 49	
	50 – 59	
	60 – 65	
	Over 65	
	Prefer not to say	
Sexual orientation:	Heterosexual	
	Homosexual	
	Bisexual	
	Transsexual	
	Undergone gender reassignment	
	Prefer not to say	
Disabilities:	None	
	Physical disability	
	Mental disability	
	Prefer not to say	
Race/nationality/ethnic origin:	White	English	
		Scottish	
		Welsh	
		Irish	
		British	
		Other white background 
(please specify)	
	Mixed	White and 
Black Caribbean	
		White and Black African	
		White and Black British	
		White and Asian	
		Other mixed background
(please specify)	
	Asian	Indian	
		Pakistani	
		Bangladeshi	
		British	
		Other Asian background
(please specify)	
	Black	Caribbean	
		African	
		British	
		Other black background
(please specify)	
	Chinese	
	Other ethnic group
(please specify)	
	Prefer not to say	
Religion:	Christian	
	Catholic	
	Jewish	
	Sikh	
	Muslim	
	Hindu	
	Buddhist	
	Rastafarian	
	None	
	Other religion
(please specify)	
	Prefer not to say	

For the purposes of compliance with the Data Protection Act 1998, I hereby confirm that by completing this form I give my consent to Dance City processing the data supplied on this form for the purpose of equal opportunities monitoring.