Equal Opportunities in Employment

Monitoring Questionnaire

Kensington and Chelsea TMO values and respects the diversity of all people. This is why we
have policies in place to ensure successful candidates are appointed solely on their ability to
do the job, irrespective of race, sex, sexuality, age, disability, religion or belief.

We are committed to ensuring equal access to employment. We therefore ask candidates a

number of questions relating to those grounds on which the law currently prohibits
discrimination and those on which it will prohibit discrimination in the near future. Details
obtained from this form will allow us to identify which groups are under-represented within
our organisation. By monitoring all stages of the recruitment process, we are able to check
discrimination is not taking place. We would therefore ask you to take the time to complete
this form.

Whilst we are committed to monitoring all aspects of equality and diversity, we acknowledge
that some people may be unwilling to disclose details about their sexuality and religious
beliefs. If you do not wish to provide information in these categories, please put an X in the
prefer not to say boxes.

The information contained within this form will be input into a database and used for
recruitment and selection monitoring purposes only. It is separated from the application form
at the time it is received and will not form part of the selection process. If you are
successful, the information will be transferred to your personal record at that time. The
information will be kept in strict confidence and will be used for monitoring purposes only.
Under the Data Protection Act employees are entitled to request to see information that is
held on them at any time.

Please fill in the appropriate box in each section with an X.

Racial Origin and Religion
The categories of racial origin and religion reflect those chosen by the Office for National
Statistics for the 2001 UK population Census with added categories based upon local
census data.

Surname, first name Date of Birth

Where did you see

Job Applied for
advert?

Section

GENDER
IDENTITY
Female Male Transgender Prefer not to say

RACIAL ORIGIN
I would describe myself as (please tick the appropriate box):
White Asian or Asian British

1 British 1 African Indian

2 Irish 2 Indian

3 Other European 3 Pakistani

4 Any other White background 4 Bangladeshi

5 Any other Asian background

Mixed

1 White and Black Caribbean Any other group

2 White and Black African 1 Moroccan Arab

3 White and Asian 2 Other Arab

4 Any other mixed background 3 Chinese

4 Filipino

Black or Black British 5 Somalian

1 Caribbean 6 Any other ethnic background

2 African

3 Any other Black background Prefer not to say

SEXUAL ORIENTATION
Prefer
Heterosexual Gay or
Bisexual Other not to
or Straight Lesbian
say
RELIGIOUS BELIEF
Christian Muslim Jewish Buddhist Hindu Sikh
No Prefer not
Other religion (please state)
religion to say
DISABILITY
The Disability Discrimination Act 1995 defines disability as a physical or mental impairment which has a
substantial and long term adverse effect on a persons ability to carry out normal day to day activities.

Do you consider yourself to have a disability? Yes No

If Yes, please specify: