Interim Executive Director - Equal Opportunities Form

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* 1. Position Applied for

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* 2. I identify my gender as

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* 3. Age

16 - 19

20 - 34

35 - 49

50 - 64

65+

Prefer not to say

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* 4. What is your ethnicity? Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you think you belong. Please tick the appropriate box

White English

White Welsh

White Northern Irish

White Irish

White Scottish

White British

White & Black Caribbean

White & Black African

White & Asian

Indian

Chinese

Pakistani

Bangladeshi

Black Caribbean

Black African

Arab

Other ethnic group

Prefer not to say

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* 5. What is your sexual orientation?

Heterosexual

Bisexual

Lesbian/Gay

Other

Prefer not to say

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* 6. What is your religion or belief?

No Religion

Buddhist

Christian

Hindu

Jewish

Muslim

Sikh

Any other religion

Prefer not to say

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* 7. Disability - The Equality Act defines a disabled person as someone who has a physical or mental impairment that has a substantial and long term adverse effect on their ability to perform day to day activities. It also covers people who have been diagnosed HIV, Cancer or Multiple Sclerosis. Does this definition apply to you?

Yes

Prefer not to say

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* 8. Are you married or in a civil partnership?

Yes

Prefer not to say

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* 9. Do you have any caring responsibilities?

None

Primary carer of child/children (under 18)

Primary carer of disabled adult (18+)

Secondary carer

Primary carer of disabled child/children

Primary carer of older person (65+)

Prefer not to say