Equal Opportunities Form

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* 1. Initials

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* 2. Preferred Pronoun

Her/She

He/Him

They/Them

Prefer not to say

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* 3. What is your date of birth?

Date (DD/MM/YYYY)

Date

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* 4. Do you perceive yourself to have a disability?

Yes

No

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* 5. For the purposes of an interview would you require any arrangements, for example wheelchair access. If so, please state...

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* 6. What is your ethnicity? (Please select all that apply.)

White British

White Irish

Other White Background

White & Black African

White & Black Caribbean

White & Asian

Other mixed background

Indian

Pakistani

Other Asian background

Black Caribbean

Black African

Other Black background

Chinese

Other (please specify)