Dearden is committed to the promotion of equality of opportunity in its employment policy, practices and procedures. To make this meaningful we need to monitor the effectiveness of our policies, by analysing statistical information.

We would be grateful if you could complete the form below – we value your contribution, which will ensure our statistics are accurate and representative of people who are seeking employment through us.

This form will be separated from your application form and treated in the strictest confidence. The information you provide will be used for statistical purposes only and will not be used as part of the recruitment selection process. It is helpful if you complete all sections of the form.
Notes on completing this form:

Ethnic Origin:

The ethnic origin categories the same as those used in the population census in 2001. They are recommended by the Commission for Racial Equality and are the basis for reporting statutory performance indicators.


The definition of disability under the Disability Discrimination Act 1995 is “a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities”.

I would describe my ethnic origin as:

Any other Ethnic Origin:

My Gender:
 Male Female Prefer not to say

Do you consider yourself to have a disability?
 No Yes

What is the effect of your disability or health condition?

My Age Group:

What is your Religion and Belief

Any other Religion and Belief: