Equal Opportunities Monitoring form			CONFIDENTIAL

Jean Lambert MEP wants to monitor who applies for jobs in order to assess the effectiveness of her equal opportunities policies.  You do not have to return this form, but doing so will help Jean’s equal opportunities objectives.  You do not have to answer every question.  This form will be separated from your application and will form no part of the selection process.

Post:		JL012016

Your Name:	________________________________________ [leave blank if preferred]

Gender
	What is your gender? 				[  ] Female	[  ] Male
 		Have you ever identified as transgender? 	[  ] Yes	[  ] No

Ethnic Origin

Asian / Asian British:		[  ]  Bangladeshi		[  ]  Indian
			[  ]  Pakistani		[  ]  Any other Asian background

Black / Black British:	[  ]  African		[  ]  Caribbean
								[  ]  Any other Black background
[  ]	Chinese
[  ]	Kurdish
[  ]		Sikh
[  ]		Turkish
[  ]		Dual heritage (please specify) _________________________________

White:	[  ]  British	[  ]  Irish	[  ]  Any other White background

[  ]	Any other ethnic group (please specify) __________________________	
[  ]		Prefer not to say

Age	_________ [leave blank if preferred]

Sexual orientation
	[  ]	Bisexual	[  ]	Heterosexual/straight
	[  ]	Gay man 	[  ]	Other _____________
	[  ]	Gay woman/lesbian	[  ]	Prefer not to say

Faith/religion
	[  ]	Buddhist	[  ]	Sikh
	[  ]	Christian	[  ]	None
	[  ]	Hindu		[  ]	Other (please specify) ____________
	[  ]	Jewish	[  ]	Prefer not to say
	[  ]	Muslim

Disability
Do you consider yourself to be a disabled person?		[  ] Yes	[  ] No