equal opportunity

EQUAL OPPORTUNITIES MONITORING FORM



Ross & Roberts Ltd is an Equal Opportunities employer we are fully
committed to the principles of this policy and to the implementation of the
legislation and its code of practice.

Ross & Roberts will ensure a working environment in which all people are
able to give of their best, that is free from harassment and bullying and
that all decisions will be based on merit.

All of our decisions in regards to recruitment, assessment, selection,
training, promotion and employment practices aim to be objective and free
from bias.

This form is optional and anonymous, and it is not form part of any part of
the recruitment and selection process and is separated from the application
form before we shortlist candidates for the position.

Position applied for: Administration Officer

Please tick as appropriate:

Gender: F M


Age: Under 25 25-34
35-44

45-54 55-64
65-75

Marital Status:

Married
Single

Divorced
Other:…………………….







Disability:

Do you consider yourself disabled? YES NO

If your answer is YES please state what is the nature of your disability:
……………………………………………………………………………………………………………………………………………………………………………………
Do you have any learning difficulties? YES NO

If your answer is YES please state what is the nature of it:
……………………………………………………………………………………………………………………………………………………………………………………

What Nationality are you? Nigerian

What is your religion? Christian

Ethnic group:

White Mixed

White British Mixed white
and Black Caribbean

White Irish Mixed
White and Black African

Any other white background Mixed white and Asian

Any other Mixed background

Black Asian

African Indian

Caribbean Pakistani

Other Chinese

Other



Date: 16-07-2012

Name (optional): Cynthia Osagie REFERENCE: (Office)
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Application No.

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