Sensitive Personal Data
Equality and Diversity Monitoring Form

DepaxCare wants to meet the aims and commitments set out in its Equality and Diversity 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.
We need your help and co-operation to enable us to do this, but filling in this form is voluntary.
The information you provide will stay confidential and will be stored securely and limited to only
authorised staff in our team.
Gender *
Are you married or in a civil partnership? *
Age *
What is your Ethnicity?
Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you
perceive you belong. Please tick the appropriate box.
Mixed/multiple ethnic groups
Asian/Asian British
Black/ African/ Caribbean/ Black British
Other ethnic group
Do you consider yourself to have a disability or health condition? *
The information in this form is for monitoring purposes only. If you believe you need a ‘reasonable
adjustment’, then please discuss this with your manager, or the manager running the recruitment
process if you are a job applicant.
What is your sexual orientation? *
What is your religion or belief? *

Sign *