CONFIDENTIAL

Equal Opportunities Monitoring Form

Dear Candidate The Wallace Collection has a policy of equal opportunity. Everyone who is eligible to join the Wallace Collection whatever their gender, sexual preference, marital status, religious grouping, race, colour, ethnic or national origins, will receive equal treatment when applying for jobs. Our selection criteria and procedures are frequently reviewed to ensure that individuals are selected, promoted and treated on the basis of their relevant merits and abilities. In order to ensure that we are meeting our aims, we routinely collect information on ethnic origin, gender and disability from all candidates for monitoring purposes. This form will be separated from the rest of your application and will not be used for short listing or selection purposes. This information will not be available for any purpose other than present/future equal opportunities monitoring. Information on this form will be held in the strictest confidence and in accordance with processing Sensitive Data as defined by Data Protection Act 1998.

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Please return the completed questionnaire with your application form.

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Full Name: Section A: Gender Male: Section B- Nationality and Ethnicity Nationality:

Date of Birth: Female:

Ethnicity (Please tick one box under the appropriate heading) Asian Bangladeshi : Indian : Pakistani: Any other Asian background (specify if you wish) : Black African : Caribbean : Any other Black background (specify if you wish) : Chinese Any Chinese background (specify if you wish) : Mixed Ethnic Background Asian and White : Black African and White: Black Caribbean and White: Any other Mixed Ethnic background (specify if you wish) : White British: Irish Any other White background (specify if you wish) : Any Other Ethnic Background Any other Ethnic background (specify if you wish) :

Section C: Disability

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Section one of the Disability Discrimination Act defines a person having a disability if s/he, has a physical or mental impairment which has substantial and long term adverse effect on his or her ability to carry out normal day to day activities Do you consider that you have a disability? Yes: No: If you consider yourself disabled, is there anything that the Collection could do to facilitate your application?

(Please give details of any requirements you may have if invited for an interview) If you are appointed to this post do you feel that any special aids or equipment would be required to take account of your disability? Please give details

Thank you for your cooperation.