Equality and diversity monitoring form

Prospect Hospice actively encourages applications from people from all backgrounds. We want to ensure that we meet the aims and commitments set out in our equality policy, this includes not discriminating under the Equality Act 2010 and building an accurate picture of those who apply to work with us. The organisation needs your help and co-operation to enable us to do this, but filling out this form is voluntary.
Marriage or civil partnership
Sexual orientation

Ethnic origin

Please tick one of the following:
Asian/Asian British
Black/ African/ Caribbean/ Black British
Mixed/ Multiple ethnic groups
Other ethnic groups
Religion or belief


The Equality Act 2010 defines a disabled person as someone who has a physical or mental impairment which has substantial and long-term adverse effects on their ability to carry out normal day to day activities.
Do you consider yourself to be disabled
Caring responsibilities

Thank you

Thank you for taking the time to fill in this confidential form. Please click the submit button to send your form.