Equal Opportunities In Employment Application Form Page 2
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5CONFIDENTIAL
5 My Nationality is
My Ethnic Origin is (please mark one box only – X)
6
White
Black/African/Caribbean/British
Other ethnic group
English, Welsh, Scottish, British
Black or Black British - Caribbean
Arab
Irish
Black or Black British - African
Other Ethnic background
Gypsy or Traveller
Other Black background
Information refused
Any other white background
Asian/Asian British
Mixed / Multiple ethnic group
Asian or Asian British - Indian
Mixed - White and Black Caribbean
Asian or Asian British - Pakistani
Mixed - White and Black African
Asian or Asian British - Bangladeshi
Mixed - White and Asian
Chinese
Other Mixed background
Other Asian background
7 What is your Religious Belief? (This is an optional question)
No religion or belief
Muslim
Christian
Sikh
Buddhist
Any other religion or belief
Hindu
Prefer not to say
Jewish
8 What is your Sexual Orientation? Sexual Orientation means who you are emotionally attracted to.
(This is an optional question).
Straight / Heterosexual
Gay Man
Gay Women / Lesbian
Bisexual
Other
Prefer not to say
Personal Details
Surname / Family Name:
.......................................................................................................................................................
First Names (in full):
........................................................................................... Title (Mr/Mrs/Dr/Prof etc) ...................
Address:
...............................................................................................................................................................................................................
...............................................................................................................................................................................................................
...................................................................................................................... Postcode: ..........................................
Data Protection - I agree to the University of Liverpool recording and using personal data contained in this form for
the purpose of monitoring the University’s Diversity & Equality of Opportunities Policy, and for statistical purposes.
Signed (type name) .......................................................................................................... Date ..................................................
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