EQUAL OPPORTUNITIES MONITORING FORM

DIVERSITY We measure it because it matters The Sammons Group is an EQuality Assured recruiter (as endorsed by the REC), and is committed to promoting diversity in the workplace. To help us measure how effective we have been in communicating with and attracting a diverse range of people to work with, you are requested to complete this form and return it with your application form. Copies of our diversity policy are available upon request. We are sensitive to the fact that some people would rather not complete diversity forms - either because they fear the information will be misused, or because they consider some of the questions to be highly personal. We would like to put your mind at rest. We promise that this information is kept separate from the information used in recruitment decisions, and where it is shared with clients we have obtained guarantees that they will not use the information to influence recruitment decisions either. All information is strictly confidential, and is PURELY for statistical purposes – only shared with a restricted number of authorised personnel. We will not discriminate against individuals who decide not to complete the form. However, we ask that as many people as possible agree to help us measure diversity – because it matters to us.

------------------------------------------------------------------------Name: Address: Please tick the boxes that apply to you: Sex

Male

Female

Sexual Orientation

I would describe my sexual orientation as:

Disability Status

Disabled

Not disabled

Age

Age

Date of Birth

Unspent Convictions (as defined by the Rehabilitation of Offenders Act 1974)

Yes

None

Please choose one For advice, call the Equality & Human Rights Commission on: 0845 604 6610

An UNSPENT conviction is one where the rehabilitation period has not expired

Please turn over for page 2 The Sammons Group www.sammons.co.uk

Diversity - Page 2

Religion

I would describe my religion as:

Ethnic Category

White

Please tick the box that best describes your ethnic origin – UK citizens can belong to any of these categories (we use the same categories as the UK census) – this question does not relate to nationality

Please choose one

British Irish Gypsy/Irish Traveller Any other white background Please specify Mixed White & Black Caribbean White & Black African White & Asian Any other mixed background Please specify Asian Indian Pakistani Bangladeshi Chinese Any other Asian background Please specify Black Black Caribbean Black African Any other Black background Please specify Arab or Other Arab Other Please specify

Thank you for taking the time to complete this form. You have helped us monitor our ongoing commitment to treating everyone fairly – according to their ability, and nothing else. The Sammons Group www.sammons.co.uk