Part C Part C Job you have applied for: Equalities Equal Opportunities Monitoring Form Why are we asking for this information? Salford CVS is committed to ensuring that our activities, including recruitment follows good practice in equality and inclusion. The information from this form enables us to monitor the effectiveness of our equal opportunities practice and to ensure that we are open to all. Any information that you provide will remain anonymous and separated from you application before submission to the recruitment panel. Salford CVS is a member of the Data Protection Register. What is your gender? Female Male Prefer not to say Other Is your gender identity the same as the gender you were assigned at birth? Yes No What is your race / ethnicity? - None -White BritishWhite IrishWhite Gypsy or Irish TravellerWhite EuropeanOther White backgroundCaribbeanAfricanOther Black or Black BritishIndianPakistaniBangladeshiChineseOther Asian backgroundWhite/Black CaribbeanWhite/Black AfricanWhite/AsianOther Mixed backgroundArab - North African/Middle Eastern/Western AsianOther Ethnic BackgroundPrefer not to say Please specify What is your age? - None -Under 1818 - 2425 - 3435 - 4445 - 5455 - 64 65 - 7475+Prefer not to say What is your sexual orientation? - None -HeterosexualLesbianGayBisexualPrefer not to sayOther Please specify Disability markup The Disability Discrimination Act 1995 defines a disability as a ‘physical or mental impairment which has a substantial and long-term adverse effect on the ability to carry our normal daily activities’. Do you consider yourself to be disabled? Yes No Please indicate if you have: Hearing impairment Communication difficulty Visual impairment Learning difficulty Multiple impairment Mobility impairment Mental health condition Prefer not to say Other Please specify Do you consider yourself to have a long-term health condition? Yes No Do you have a religion or belief? No religion Christian (all denominations) Muslim Sikh Buddhist Hindu Jewish Any other religion Prefer not to say Do you look after a child as a parent, guardian or foster parent or help an adult to carry out their daily routine? Yes No Are you a : Carer of children Carer of adults Carer of both What is your employment status? - None -Employed - full timeEmployed - part timeSelf-employedRetiredIn education or trainingUnemployedPrefer not to sayOther Please specify