Please complete this section from information on the job advert.
Job title:
Job reference:
Closing date:
Recruitment monitoring form This section forms an integral part of the application process. This form is confidential and will not be seen by the selection panel. The information provided on this document will be used by the Trust only to monitor the effectiveness of its equal opportunities and recruitment policies and will be used only as part of aggregated statistics. Please complete the following boxes as appropriate (use black pen if completing the form by hand). Form created in-line with the UK General Data Protection Regulation (UK GDPR). Further support prior to adoption should be sourced from your Data Protection Officer. St Bartholomew’s CE Multi Academy Trust aims to ensure compliance and commitments outlined within all employment and diversity legislation including the Equality Act 2010. We encourage equality and diversity across the workforce and promote equal opportunities. Completion of this form is voluntary, however, to allow opportunity to ensure that St Bartholomew’s CE Multi Academy Trust meets compliance and commitments in line with the above statement, completion is requested. All information disclosed is kept confidential and may be used for monitoring purposes. Should you have any queries of concerns regarding this form, please contact the Trust. A completed copy of this form should be returned with your Application Form.

Gender: Male ☐ Female ☐ Intersex ☐ Non-binary ☐ Prefer not to say ☐ If you prefer to use your own gender identity, please write in: Click or tap here to enter text. 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 ☐
Ethnicity: Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong.
Asian or Asian British Indian ☐ Pakistani ☐ Bangladeshi ☐ Chinese ☐ Prefer not to say ☐ Any other Asian background Click or tap here to enter text. Black or Black British African ☐ Caribbean ☐ Prefer not to say ☐ Any other Black background Click or tap here to enter text. Other Please write in Click or tap here to enter text. Country of Birth Please write in Click or tap here to enter text.	Mixed White and Black African ☐ White and Black Caribbean ☐ White and Asian ☐ Prefer not to say ☐ Any other Mixed background Click or tap here to enter text. White British ☐ Irish ☐ Northern Irish ☐ Scottish ☐ Welsh ☐ Any other White background Click or tap here to enter text.
Disability: Do you consider yourself to have a disability or health condition? Yes ☐ No ☐ Prefer not to say ☐ What is the effect and / or impact of your disability or health condition on your work? Please write in here: Click or tap here to enter text. The information in this form is for monitoring purposes only. If you believe you need a ‘reasonable adjustment’, then please discuss this with your manager, or the manager running the recruitment process if you are a job applicant.	Sexual Orientation: Heterosexual (Straight) ☐ Gay ☐ Lesbian ☐ Bisexual ☐ Asexual ☐ Pansexual ☐ Undecided ☐ Prefer not to say ☐ If you prefer to use your own gender identity, please write in: Click or tap here to enter text.
Caring Responsibilities: 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 ☐	Religion and/or Belief: No religion or belief ☐ Buddhist ☐ Christian ☐ Hindu ☐ Jewish ☐ Muslim ☐ Sikh ☐ Prefer not to say ☐ If other religion or belief, please write in: Click or tap here to enter text.
Current Working Pattern: None ☐ Flexitime ☐ Staggered hours ☐ Term-time only ☐ Annualised hours ☐ Job-share ☐ Flexible shifts ☐ Compressed hours ☐ Homeworking ☐ Prefer not to say ☐ If other, please advise: Click or tap here to enter text.	Current Working Arrangement: Full-time ☐ Part-Time ☐ Please outline your current part-time hours: Click or tap here to enter text. Prefer not to say ☐
Are you a current employee of [Employer Name]? Yes ☐ No ☐ Prefer not to say ☐	FOR OFFICE USE ONLY: Candidate: Shortlisted ☐ Appointed ☐