Feb 18 2022 - Posted by Yvonne

Omidaze equality and diversity monitoring form

Omidaze equality and diversity monitoring form

To be completed by all applicants. Please copy and paste the questions below onto a blank document which you can attach to an email and send your completed form marked OMIDAZE EQUALITY AND DIVERSITY MONITORING FORM by email to Omidaze@outlook.com If you require this form as a word doc please email y.murphy1@ntlworld.com and we will send one as an attachment.

Omidaze wants to meet the aims and commitments set out in its equality policy. This includes not discriminating under the Equality Act 2010, and building an accurate picture of the make-up of our workforce in encouraging equality and diversity.
The organisation needs your help and co-operation to enable it to do this, but filling in this form is voluntary. The information provided will be kept confidential and will be used for monitoring purposes.
Please answer all the questions below. We will use the data provided by all our applicants to help us make sure we reaching and contracting a broad range of people. We must also report on who our funding is reaching.
Your answers on this form will not affect any decision on your application and will be used for monitoring purposes only. The form will not be shared with staff prior to assessing your application. Your application will not be considered complete unless this form has been filled in and submitted.
If you have any questions about the form contact Yvonne Murphy y.murphy1@ntlworld.com


Equality and diversity monitoring form questions

Please copy and paste and then circle or tick one option for each question and add any additional comments. Thank you for completing this form along with your application. The information in this form is for monitoring purposes only.

Gender   Male  *   Female *   Intersex * Non-binary * Prefer not to say *

If you prefer to use your own gender identity, please write in:

Is the gender you identify with the same as your gender registered at birth?

Yes ☐     No ☐     Prefer not to say ☐


Age  16-24  *     25-29  *     30-34  *       35-39  *     40-44  *    45-49          *       50-54  *       55-59  *     60-64 *     65+    *     Prefer not to say   *


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 box


Asian or Asian British

Indian   *      Pakistani  *      Bangladeshi  *     Chinese  *   Prefer not to say *

Any other Asian background, please write in:


Black, African, Caribbean or Black British

African  *       Caribbean  *     Prefer not to say *

Any other Black, African or Caribbean background, please write in:



Any specific White ethnic origin, please write in:



Any specific Arab ethnic origin, please write in:


Mixed or Multiple ethnic groups

White and Black Caribbean          *      White and Black African *      White and Asian *              Prefer not to say *

Any other Mixed or Multiple ethnic background, please write in:



Other ethnic group

Prefer not to say *    Any other ethnic group, please write in:


How would you describe your national identity

British * Welsh * English * Scottish * Northern Irish *  Other * Prefer not to say *


Do you consider yourself to have a disability or health condition?  

Yes *      No *    Prefer not to say *


What is the effect or impact of your disability or health condition on your work? Please write in here:


What is your sexual orientation?

Heterosexual *        Gay *      Lesbian  *     Bisexual  * Asexual *       Pansexual *  Undecided *           Prefer not to say  *

If you prefer to use your own identity, please write in:


What is your religion or belief?

No religion or belief *      Buddhist *  Christian *      Hindu *   Jewish   *

Muslim  *     Sikh  *  Prefer not to say *  If other religion or belief, please write in:

Do you have caring responsibilities? If yes, please tick all that apply


None  *

Primary carer of a child/children (under 18)  *

Primary carer of disabled child/children  *

Primary carer of disabled adult (18 and over)  *

Primary carer of older person  *

Secondary carer (another person carries out the main caring role)  *

Prefer not to say  *

Please send completed form marked OMIDAZE EQUALITY AND DIVERSITY MONITORING FORM to Omidaze@outlook.com