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EQUAL OPPORTUNITIES MONITORING FORMPerformances Birmingham Limited is committed to equal opportunities in its employment policy.The company is determined that in its provision of services and as an employer it will ensureequality of opportunity for all, regardless of age, race, ethnic origin, colour, religion, gender(including gender reassignment), disability, marital status or seual orientation.

To help us implement and monitor this policy we would be grateful if you could provide us withthe following information. This information will be ket searate from !o"r ali#ation forman$ will be treate$ in the stri#test #onfi$en#e%

!. Gen$er

  "ale

#. &isabilit!

The $isability $iscrimination %ct !&&' defines a person as having a disability if heshe has a physical ormental impairment which has a substantial and longterm adverse effect on hisher ability to carry outnormal day to day activities.

&o !o" #onsi$er !o"rself to ha'e a $isabilit! as $efine$ abo'e(

 

No

*f all of the above does not apply to you, however, you consider yourself to have a disability

please tic+ here

. &ate of )irth -#'!!&/0------------------------------------------------------

1. Ethni# Ori*in +)ritish++++++++++++++++++++++++++++++++++++++++++++++++

Please tic+ the bo net to the appropriate letter, % to 2, then tic+ one bo within that section to indicatehow you describe your cultural bac+ground3

A  Asian, Asian )ritish

! %PPL*4%5T 56"B27..8888(9ffice use only)

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  *ndian

  Pa+istani

  Bangladeshi

  %ny other %sian bac+ground, please state3 ----------------------------------

# %PPL*4%5T 56"B27..8888(9ffice use only)

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)  )la#k, )la#k )ritish

  4aribbean

  %frican

 

%ny other Blac+ bac+ground, please state3 ----------------------------------

-  -hinese, -hinese )ritish, -hinese En*lish, -hinese S#ottish, -hinese .elsh

or other ethni# *ro"

  4hinese

  %ny other bac+ground, please state3 ---------------------------------------

&  Mi/e$

  :hite and Blac+ 4aribbean

  :hite and Blac+ %frican

  :hite and %sian

  %ny other "ied bac+ground, please state3 ----------------------------------

E  .hite

  British

  2nglish

Thank !o" for takin* the time to #omlete this form%

%PPL*4%5T 56"B27..8888(9ffice use only)