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Wigan Council Equality and Diversity Monitoring Form We are committed to equal opportunities in employment and welcome applications from all sections of the community. In order to ensure the effectiveness of this policy and for no other purpose you are requested to place a tick in the appropriate boxes below and complete the details as required* The information is exclusively for monitoring purposes and will be kept strictly confidential* Name Address Postcode Job Applied For Department Sex Post No Male Marital Status Female Single Date of Birth Married/Civil Partners Divorced Are you currently employed within the council Yes No If yes is this an application for a higher graded post Yes Widowed What is your ethnic background Please tick the appropriate box that indicates your cultural background. A White British Irish Any other white background please specify B - Mixed White Black Caribbean African Any other Mixed C - Asian or Asian Indian D - Black or Black Pakistani Bangladeshi Any other Asian E - Chinese of other Ethnic Group Chinese Any other please specify Any other Black What is your religion Please tick the appropriate box that indicates your religious background. None Buddhist Muslim Jewish Hindu Sikh Christian Any other religion please specify The Disability Discrimination Act 1995 defines a disabled person as anyone who has had a physical or mental impairment which has a substantial and long term effect on their ability to carry out normal day to day activities. Taking this definition into consideration do you consider you have a disability If Yes please give details. How did you find out about the vacancy Signature Date Failure to complete this form will not affect your application If you believe that there has been unfair discrimination in making the appointment there is a process of investigation available subject to reasonable grounds for suspicion being identified* If you wish to pursue an unfair discrimination complaint please contact the Head of Personnel Wigan Council Town Hall Library Street Wigan WN1 1YN* Please return this form with your application form*. In order to ensure the effectiveness of this policy and for no other purpose you are requested to place a tick in the appropriate boxes below and complete the details as required* The information is exclusively for monitoring purposes and will be kept strictly confidential* Name Address Postcode Job Applied For Department Sex Post No Male Marital Status Female Single Date of Birth Married/Civil Partners Divorced Are you currently employed within the council Yes No If yes is this an application for a higher graded post Yes Widowed What is your ethnic background Please tick the appropriate box that indicates your cultural background. A White British Irish Any other white background please specify B - Mixed White Black Caribbean African Any other Mixed C - Asian or Asian Indian D - Black or Black Pakistani Bangladeshi Any other Asian E - Chinese of other Ethnic Group Chinese Any other please specify Any other Black What is your religion Please tick the appropriate box that indicates your religious background.

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