National Theatre WalesEqual Opportunities Monitoring Form

We aim to treat everyone equally, not to discriminate and to build an accurate picture of the make-up of the

workforce in encouraging equality and diversity. We need your help and co-operation to enable us to do

this, but filling in this form is voluntary. This monitoring form is for statistical purposes only and will be

separated from your job application and destroyed once the data has been collated. We thank you for your

co-operation.

What is your ethnicity?Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate boxWhite:

British Any other white background*

Irish

Mixed:

White & Black Caribbean White & Black African

White & Asian Any other mixed background*

Black or Black British

Caribbean African

Any other Black background*

Asian or Asian British

Indian Pakistani

Bangladeshi Chinese

Arab or Other Ethnic group

Arab Other Ethnic Group*

* Please specify Prefer not to say

Age16-24 25-29 30-34 35-39 40-44 45-49

50-54 55-59 60-64 65+ Prefer not to say

Gender

Female Male Prefer not to say

What is your sexual orientation?

Bisexual Heterosexual/Straight

Gay Man Other

Gay Woman/Lesbian Prefer not to say

* Please specify:

What is your religion or belief?

Buddhist Sikh

Christian Other Religion or Belief*

Hindu No Religion

Jewish Prefer not to say

Muslim

* Please specify:

Do you speak Welsh?

Yes A little No Prefer not to say

Do you consider yourself to have a disability?The Disability Discrimination Act defines disability as “A physical or mental impairment which has a substantial and long-tern effect on the person’s ability to carry out normal day to day activities”

Yes No

If yes, please state the nature of the disability:

How did you first hear about the vacancy?Newspaper / Print Journal Which one?Online Newspaper / Journal Which one?Job search website Which one?Email alert Which one?Social Media Which one?Word of mouthOther Please specify