Diversity Monitoring Questionnaire Please review our Vacancy Privacy Statement Diversity Monitoring Questionnaire I understand these details are strictly private and confidential(Required) Please select I confirm I have read the Vacancy Privacy Statement(Required) Please select Name(Required) First Last GenderPlease selectFemaleMalePrefer not to sayWhat is your gender?Is your gender identity as the sex assigned to you at birth?Please selectYesNoPrefer not to sayAgePlease select16 - 2425 - 3435 - 4445 - 5455 - 6465+Prefer not to sayWhich category includes your current age in years?Your sexual orientationPlease selectGay/LesbianHetreosexual/StraightPrefer not to sayWhat is your ethnic group?Please selectWHITEBLACK/ AFRICAN/ CARIBBEAN/ BLACK BRITISHMIXED/ MULTIPLE ETHNIC GROUPSASIAN/ ASIAN BRITISHOTHER ETHNIC GROUPPrefer not to sayWHITEPlease selectBritishIrishGypsy or Irish TravellerAny other white backgroundMIXED/ MULTIPLE ETHNIC GROUPSPlease selectWhite and AsianWhite and Black AfricanWhite and Black CaribbeanWhite and ChineseAny other mixed/ multiple ethnic backgroundBLACK/ AFRICAN/ CARIBBEAN/ BLACK BRITISHPlease selectAfricanCaribbeanAny other Black/ Black British backgroundASIAN/ ASIAN BRITISHPlease selectIndianPakistaniBangladeshiChineseAny other Asian backgroundOTHER ETHNIC GROUPPlease selectArabAny other ethnic group (please specify)The Equality Act 2010 generally defines a disabled person as someone who has a mental or physical impairment that has a substantial and long-term adverse effect on the person’s ability to carry out normal day-to-day activities. “Long–term” means that the impairment is likely to or has lasted for 12 months or more.Do you consider yourself to have a disability according to the definition above?Please selectYesnoPrefer not to sayAre 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?Please selectYes, limited a lotYes, limited a littleNoPrefer not to sayDo you have any caring responsibilities for any children or adults?Please selectYesNoPrefer not to sayWhat is your religion or belief?Please selectAtheistChristian (including Church of England, Catholic, Protestant and all other Christian denominations)HinduMuslimNo religionPrefer not to sayOtherOther: please specify
