Equal opportunities monitoring form - application to join an advisory group as a panel or board member

We are committed to following best practice in workforce monitoring. We are asking applicants to advisory group member roles to complete equal opportunities monitoring forms should they wish to supply this information. The information will be held separately from application forms, and stored anonymously and securely. Those shortlisting and appointing members will not see this information, and it will not be used to decide who to shortlist and/or appoint. We will collate the information and analyse it to reflect on our reach into the health and public health workforce. We will use the analysis to help ensure our recruitment practices are fair and appropriate. The questions below are adapted from the ONS Census 2011.



What is your gender?


What is your ethnic group?

Ethnic Group

What will be your age range as at 31 December 2017?

Age range

Are your day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months?

Health problem / disability

Your personal information is held and used in compliance with the Data Protection Act 1998. The Department of Health, National Institute for Health Research (DH NIHR) is the Data Controller under the Data Protection Act 1998 (‘the Act’). Under the Data Protection Act, we have a legal duty to protect any information we collect from you. You should be aware that information given to us might be shared with other DH NIHR bodies for the purposes of statistical analysis and other DH NIHR management purposes. We also reserve the right to share details of research applications with other approved research funding organisations outside the NIHR in order to coordinate research activity in the UK. Information collected from you will not be passed to any third party outside the NIHR except specifically as detailed above without your consent except where we are under a statutory obligation or entitled to do so by law. Applicants may be assured that DH NIHR is committed to protecting privacy and to processing all personal information in a manner that meets the requirements of the Act. You can ask for your details to be removed from our database at any time.