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Please complete the following application form.


General Details




CV Details

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EQUAL OPPORTUNITIES MONITORING

Ethnic Category

The following categories are based on those used in the 2001 census as recommended by the CRE. Please note the ethnic questions are not about nationality, place or birth or citizenship. UK citizens can belong to any of the ethnic categories indicated.

Please select below which best describes the ethnic category to which you belong:


White British Irish Other




Mixed
White and Black Carribean White and Black African
White and Asian Mixed other




Asian or Asian British Indian Pakistani Bangladeshi Asian other




Black or Black British Black Caribbean Black African Black other




Chinese Chinese Chinese other




Traveller Community If you are a member of the Traveller Community, please complete this section:

Gypsy/Romany Irish Traveller Traveller other




Other Other Prefer Not to Say
Gender

Male Female Prefer Not to Say



If you identify as transgender, please tick appropriate box:

Male Female Prefer Not to Say
Disability

Yes No Prefer Not to Say


Hearing impairment and/or speech impairment
Visual/sight impairment
Learning disability/difficulty (such as Down's Syndrome or Dyslexia) or                  cognitive impairment (such as Autistic Spectrum disorder)
Mental Health Condition, such as depression or schizophrenia
Physical Impairment, such as difficulty using your arms or mobility issues                   which mean using a wheelchair or crutches
Long-standing illness or health condition such as Cancer, HIV, Diabetes,                   Chronic Heart Disease, or Epilepsy
Neurological conditions, eg Epilepsy, MS
Any other specific disability needs or health condition you wish to declare




Yes No Prefer Not to Say
Reasonable Adjustment

Yes No Prefer Not to Say
Communication Needs : Information in Alternate Formats

In larger print (Example Arial size 16)
In Braille
In audio format (eg CD, audiotape
British Sign Language interpreter support needed
In any other format (please specify)
Age

16-17 18-24
25-34 35-44
45-49 50-54
55-59 60-64
65 or over

Prefer Not to Say
Religion

None
Buddhist
Christian - Catholic/Protestant
Hindu
Jewish
Muslim
Sikh
Any other religion or belief


Prefer Not to Say
Sexual Orientation

Heterosexual or straight
Gay
Lesbian
Bi-sexual
Other


Prefer Not to Say
Data Protection

Yes
No