Diversity monitoring form

Conciliation Resources values diversity and inclusion, seeks to ensure there is no unfair discrimination in its
working practices and to take positive steps to support staff, volunteers and trustees from groups that are or
have been disadvantaged through discrimination.
For this reason we want to monitor our recruitment procedures. We will separate this form from the
application form. It will not form part of the selection process.
Please tick the appropriate boxes:
Post applied for
Mindanao Projects Officer
How/where did you hear about this
CR website

EPLO

vacancy? Please use the relevant

Email from CR

Other website (please state)

check box to indicate where you first

Charity Jobs

came across this vacancy.

PCDN
Idealist

Gender
Male

Female

Other

Prefer not to say

Is your gender identity different from the sex you were assigned at birth?
Yes

No

Prefer not to say

What age group do you belong to?

18-24

25-34

35-44

45-55

over 55

Prefer not to say

How would you describe your sexuality?

Heterosexual/straight

Gay man

Other

Prefer not to say

Gay woman/lesbian

Bisexual

Do you consider that you have a disability?

Yes

No

Prefer not to say

Do you have a disability as defined by the Disability Discrimination Act?

Yes

No

Prefer not to say

I don't know

Burghley Yard 106 Burghley Road London NW5 1AL UK

+44 (0)20 7359 7728
+44 (0)20 7359 4081
cr@c-r.org
www.c-r.org
Conciliation Resources is a company limited by guarantee (3196482) and a charity registered in England and Wales (1055436)

Do you consider that you have a long-term health problem?

Yes

No

Prefer not to say

How would you describe your religion or belief?

My religion or belief is ______________________________
I have no religion or belief
Prefer not to say

How would you describe your nationality?

British
Other

English

Scottish

Welsh

Irish

(please describe) ______________________________

How would you describe your ethnic origin?

White/Mixed
White

White and Black Caribbean

Any other Mixed background

White and Black African

White and Asian

(please describe) ______________________________

Asian
Indian

Pakistani

Any other Asian background

Bangladeshi
(please describe) ______________________________

Black
Caribbean

African

Any other Black background

(please describe) ______________________________

Chinese
Chinese

Any other ethnic group/background

, please describe ______________________________

Prefer not to say

Burghley Yard 106 Burghley Road London NW5 1AL UK

+44 (0)20 7359 7728
+44 (0)20 7359 4081
cr@c-r.org
www.c-r.org
Conciliation Resources is a company limited by guarantee (3196482) and a charity registered in England and Wales (1055436)

Thank you for your help in completing this form.

Burghley Yard 106 Burghley Road London NW5 1AL UK

+44 (0)20 7359 7728
+44 (0)20 7359 4081
cr@c-r.org
www.c-r.org
Conciliation Resources is a company limited by guarantee (3196482) and a charity registered in England and Wales (1055436)