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artsdepot is committed to equal opportunities. In order to help us to monitor how effectively our recruitment procedure meets this aim, please complete this form and return it with your application. The information you provide will only be used to check how effectively our recruitment procedures are working. The form will be separated from your application as soon as we receive it and will not be passed on to anyone involved in shortlisting. Position applied for _____________________________________ Advertisement seen in _________________________________________ PLEASE TICK THE APPROPRIATE BOXES

ETHNIC ORIGIN I would describe myself as: Asian or Asian British

White or White British

Bangladeshi

British

Chinese

Greek Cypriot

Indian

Turkish Cypriot

Pakistani

Irish

Other Asian (please describe)_____________________

Other White (please describe)_______________________

Black or Black British

Other Ethnic Group

African

Other Ethnic Group (please describe) _____________________

Caribbean Other Black (please describe) ____________________ Mixed Background Asian and White Black African and White Black Caribbean and White Other Mixed (please describe)______________________

AGE 16 – 20

26 – 35

46 – 55

60 - 64

21 – 25

36 – 45

56 – 59

65 and over

GENDER DISABILITY

Female

Male

Would you describe yourself as having a disability?

Yes

No


Equal Opportunities Monitoring