Haringey Equal Opps form  20/1/09  11:28 am  Page 1
RECRUITMENT MONITORING FORM: 
CONFIDENTIAL
As an equal opportunities employer, the Council is committed to monitoring the effectiveness of its employment policies.
This is endorsed by the Equal Opportunities Commission and the Commission for Racial Equality. All stages of the recruitment
process are monitored to check that unfair discrimination is not taking place. The information you provide below will be treated
in strict confidence unless indicated otherwise. Categories marked with a † will only be available to HR and used for statistical
monitoring purposes.
Post title  ...................................................................................................... Advert ref no ....................................................................................
Surname ...................................................................................................... Initials ..................................................................................................
Title  (Miss/Ms/Mrs/Mr/Dr)  .................................................................. (Other)  ................................................................................................
Do you live in the Haringey borough?  Yes          No
AGE Date of birth (dd/mm/yyyy)  ....................................................
GENDER
Male    
Female
† Does your gender identity differ from your birth sex?  Yes
No
ETHNICITY
What is your ethnic group?
Asian or Asian British
(Please tick one box from the appropriate section)
Indian
Pakistani   
White
Bangladeshi
East African Asian   
British
Irish
Greek/Cypriot   
Any other Asian background *
Turkish             Gypsy ............Turkish/Cypriot
Black or Black British
Kurdish
Irish Traveller      
Caribbean
African    
Any other white background * 
Any other Black background * 
Mixed
Chinese or other ethnic group
White & Black Caribbean   
Chinese   
Any other ethnic background * 
White & Black African       
White & Asian   
* Other please specify ..........................................................
Any other mixed background *
DISABILITY
Do you consider you have a disability? 
Yes
No
The Disability Discrimination Act defines a disability as follows: a person has a disability if she/he has a physical 
or mental impairment which has a substantial and long-term adverse affect to his/her ability to carry out normal 
day-to-day activities
Do you have any specific requirements in relation to attending an interview or to assist you at work?
Yes
No
If YES, please give details  ....................................................................................................................................................................................
RELIGION† What is your religion?   
Buddhist   
Hindu   
Muslim   
Sikh   
Christian
Jewish
Rastafarian   
None   
Prefer not to say   
Other ..........................................................
SEXUAL ORIENTATION† I would describe my Sexual Orientation as:
Bi-sexual   
Lesbian   
Gay Man
Heterosexual   
Prefer not to say
EMPLOYMENT
Do you currently work for Haringey Council?   
Yes
No
If YES, in what capacity?   
Permanent    
Temporary    
Agency staff    
Casual staff 
How did you find out about this job? If from an advertisement please state the media title 
............................................................................................................................................................................................................................................

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