Equality and diversity monitoring form

Equality and diversity monitoring form

Starcare Ltd aims to meet our commitments as set out in its equality policy. This includes not discriminating under the Equality Act 2010 and building an accurate picture of the make-up of the workforce in encouraging equality and diversity.

The organisation needs your help and co-operation to enable it to do this but filling in this form is voluntary.

The information you provide will stay confidential and be stored securely and limited to only some staff in the organisation’s Human Resources section.

Your Name: (Required)

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Gender (Required) —Please choose an option—MaleFemalePrefer not to say

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Are you married or in a civil partnership? (Required) —Please choose an option—YesNoPrefer not to say

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Age (Required) —Please choose an option—16-2425-2930-3435-3940-4445-4950-5455-5960-6465+Prefer not to say

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White (Required)
—Please choose an option—EnglishWelshScottishNorthern IrishIrish BritishGypsy or Irish TravellerPrefer not to say
Any other white background, please write in:

Mixed/multiple ethnic groups
—Please choose an option—White and Black CaribbeanWhite and Black AfricanWhite and AsianPrefer not to say
Any other mixed background, please write in:

Asian/Asian British
—Please choose an option—IndianPakistaniBangladeshiChinesePrefer not to say
Any other Asian background, please write in:

Black/ African/ Caribbean/ Black British
—Please choose an option—AfricanCaribbeanPrefer not to say
Any other Black/African/Caribbean background, please write in:

Other ethnic group
—Please choose an option—ArabPrefer not to say
Any other ethnic group, please write in::

Do you consider yourself to have a disability or health condition? (Required)
—Please choose an option—YesNoPrefer not to say

What is the effect or impact of your disability or health condition on your ability to give your best at work and in particular a Support Worker role and providing care to vulnerable adults? Please write in here:

Function essential to the role of support worker.
As the role of support worker requires an employee to be able to carry out mobility assistance with our service users, the ability to carry out such duties is essential to your role: Is there anything that could prevent you from carrying out such essential duties?

The information in this form is for monitoring purposes only. If you believe you need a ‘reasonable adjustment’ to attend the interview, then please discuss this with your manager, or the HR Manager running the recruitment process if you are a job applicant.

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What is your religion or belief? (Required)
—Please choose an option—No religion or beliefBuddhistChristianHinduJewishMuslimSikhPrefer not to say
If other religion or belief, please write in:

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Do you have caring responsibilities? If yes, please tick all that apply
—Please choose an option—NonePrimary carer of a child/children (under 18)Primary carer of disabled child/childrenPrimary carer of disabled adult (18 and over)Primary carer of older personSecondary carer (another person carries out the main caring role)Prefer not to say