Equal Opportunities Monitoring Self-Classification Form

Tricycle Theatre Company Equal Opportunities Monitoring Self-Classification Form

Equal Opportunities The Tricycle is committed to equality of opportunity and access for all, irrespective of their age, gender, class, marital status, nationality, ethnic origin, disability, religious belief or sexual orientation. The aim of this policy is to create a working environment which values and respects the variety of life styles and cultures found within theatre and within our local community. The Tricycle is committed to equality of opportunity in which individuals are selected for employment and treated on the basis of their relevant merits. The Tricycle aims to reflect the diversity of Brent in its recruitment.

Monitoring To help us monitor the effectiveness of the Tricycle’s policy, please supply the information requested below. This information will be kept securely and will not be made available to anyone before or during short-listing. It will not be used in deciding whether to shortlist you for interview or offer you employment. The following information is being gathered to monitor the Company’s equal opportunities policy. The data will be treated in the strictest confidence and will be used only for general statistical purposes.

I consent to the data I provide being kept in this manner and only used for the purposes explained above.

Post applied for ______

Name ______

Signature ______

Date ______

1. ETHNIC ORIGIN Ethnic origin refers to members of an ethnic group who share the same cultural background and identify. This does not refer to country of birth or nationality. Please put a tick next to one of the following. I would describe my ethnic origin as:

The Tricycle is an equal opportunities employer WHITE ( ) British (English/Welsh/Scottish/Northern Irish/British ( ) Irish ( ) Gypsy or Irish Traveller ( ) Any other white background (please specify)......

MIXED ( ) White and black Caribbean ( ) White and Black African ( ) White and Asian ( ) Any other Mixed background (please specify)......

ASIAN OR BRITISH ASIAN ( ) Indian ( ) Pakistani ( ) Chinese ( ) Any other Asian background (please specify)......

BLACK OR BLACK BRITISH ( ) African ( ) Caribbean ( ) Any other Black/African/Caribbean background (please specify)......

ARAB OR OTHER ETHNIC GROUP ( ) Arab ( ) Any other ethnic group (please specify)......

PREFER NOT TO SAY ( ) Prefer not to say

HOW WOULD YOU DESCRIBE YOUR GENDER?

The Tricycle is an equal opportunities employer ( ) Female ( ) Male ( ) Prefer not to say

DO YOU CONSIDER YOURSELF TO BE DISABLED? ( ) Yes ( ) No ( ) Prefer not to say

If you have answered yes, please indicate the type of impairment which applies to you: ( ) Visual impairment ( ) Hearing impairment/deaf ( ) Physical disabilities ( ) Cognitive or learning disabilities ( ) Mental Health ( ) Other long-term/chronic conditions

HOW WOULD YOU DESCRIBE YOUR SEXUAL ORIENTATION? ( ) Bisexual ( ) Gay man ( ) Gay woman/lesbian ( ) Heterosexual/straight ( ) Prefer not to say

WHAT IS YOUR AGE? ( ) 0-19 ( ) 20-34 ( ) 35-49 ( ) 50-64 ( ) 65+ ( ) Prefer not to say

HOW DID YOU HEAR ABOUT THE JOB? Please specify:

The Tricycle is an equal opportunities employer