Equality and Diversity Monitoring Form

Home Carers Ltd aims to meet our commitments as set out in its equality policy. This includes not discriminating under the Equality Act 2010 and building an accurate picture of the make-up of the workforce in encouraging equality and diversity.

The organisation needs your help and co-operation to enable it to do this but filling in this form is voluntary.

The information you provide will stay confidential and be stored securely and limited to only some staff in the organisation’s Human Resources section.

Your Name:

Gender

Are you married or in a civil partnership? (Required)

Age

Ethnicity

White

Mixed/multiple ethnic groups

Asian/Asian British

Black/ African/ Caribbean/ Black British

Other ethnic group

Add any other information relating to your ethnicity

Do you consider yourself to have a disability or health condition?

What is the effect or impact of your disability or health condition on your ability to give your best at work and in particular a Support Worker role and providing care to vulnerable adults? Please write in here:

Function essential to the role of support worker.
As the role of support worker requires an employee to be able to carry out mobility assistance with our service users, the ability to carry out such duties is essential to your role: Is there anything that could prevent you from carrying out such essential duties?

The information in this form is for monitoring purposes only. If you believe you need a ‘reasonable adjustment’ to attend the interview, then please discuss this with your manager, or the HR Manager running the recruitment process if you are a job applicant.

What is your religion or belief?

If other religion or belief, please write in:

Do you have caring responsibilities? If yes, please tick all that apply

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

Equality and Diversity Monitoring Form

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