Equal Opportunities Recruitment Monitoring FormStrictly Confidential

The United Reformed Church (URC) is committed to promoting fairness and eliminating discrimination from recruitment and selection practices. We will ensure that no job applicant or employee receives less favourable treatment either directly or indirectly, on the grounds of age, race, disability, gender, gender reassignment, marital status, religion1 or belief, sexual orientation or pregnancy and maternity.To monitor the success of this, the URC asks all applicants to provide the information requested below. All information supplied will be treated in confidence and will not be seen by staff directly involved in the appointment. The monitoring form will be detached from your application form, stored separately and used solely to provide statistics for monitoring purposes.

Name: Date:

Position applied for:

1. Gender: Male Female

2. Date of birth:

3. Marital status: Married/Civil Partnership Single Divorced Other (Please specify …………………………)

4. Nationality:

5. How would you describe your ethnic origin? Please choose the option that best describes your ethnic group or background

White Black or black British1 Scottish/English/Welsh/

Northern Irish/British 14 African2 Irish 15 Caribbean3 Gypsy or Irish Traveller 16 Other black background

4 Other white background Please describe…………………………

Mixed Other ethnic groups5 White and black Caribbean 17 Chinese6 White and black African 18 Other ethnic groups7 White and Asian Please

describe………………………..8 Other mixed background 19 Not statedAsian or Asian British9 Indian10 Pakistani11 Bangladeshi12 Chinese13 Other Asian background Categories are those recommended by

the office for national statistics (ONS) Please

1 Except as is legally permissible where it is determined that there is a genuine occupational requirement that the post be filled by a Christian. If this is the case it will be clearly stated on all recruitment materials.EORM January 2015 Page 1 of 3

Equal Opportunities Recruitment Monitoring FormStrictly Confidential

describe…………………………

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6. Disability is defined by the Disability Discrimination Act as:

“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.” The disability could be physical, sensory or mental and must be expected to last at least 12 months.

Do you consider yourself to be disabled as defined by the Disability Discrimination Act? Yes No

Thank you for completing this form. Please return it with your application form.

The information you have provided here will stored either on paper records or electronically in accordance with the Data Protection Act 1998 and will be used solely to monitor the effectiveness of the United Reformed Church’s Equal Opportunities Policy relating to recruitment and employment.

I hereby give my consent to the United Reformed Church processing the data supplied in this form for the purposes described above.

Applicants signature: Date:

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