16-18 YRS 19-21 YRS 22-34YRS 35-44 YRS 45-54 YRS 55-64 YRS □ □ □ □ □ □ 65 YRS AND OVER PREFER NOT TO SAY □ □ MARITAL STATUS SINGLE MARRIED/CIVIL PARTNERSHIP CO-HABITATING OTHER PREFER NOT TO □ □ □ □ SAY □ DISABILITY Do you consider that you have a disability? YES NO PREFER NOT TO SAY □ □ □ If YES, please give brief details of the disability and any adjustments which would need to be made to enable you to carry out the duties listed for this post (continue on a separate sheet if necessary). RACE Please make sure that you read all the categories and then tick the box that applies to you. White: BRITISH IRISH ANY OTHER WHITE BACKGROUND (please specify): □ □ □ Mixed race: WHITE AND BLACK CARIBBEAN WHITE AND BLACK AFRICAN WHITE □ □ AND ASIAN ANY OTHER MIXED BACKGROUND ( please specify): □ □ Asian or Asian British: INDIAN PAKISTANI BANGLADESHI □ □ □ ANY OTHER ASIAN BACKGROUND specify): □(please Black or Black British: CARIBBEAN AFRICAN ANY OTHER BLACK BACKGROUND □ □ □ Chinese or ethnic: CHINESE ANY OTHER (please specify):Prefer not to say: □ □ □ SEXUAL ORIENTATION LESBIAN/GAY BI-SEXUAL HETEROSEXUAL PREFER NOT TO SAY □ □ □ □ RELIGION CHRISTIAN (including Church of England/Scotland/Ireland, Catholic, Protestant and all other Christian denominations) BUDDHIST HINDU JEWISH MUSLIM SIKH □ □ □ □ □ □ ANY OTHER RELIGION (please specify): PREFER NOT TO SAY □ □
16-18 YRS □ 19-21 YRS □ 22-34YRS □ 35-44 YRS □ 45-54 YRS □ 55-64 YRS □ 65 YRS AND OVER □ PREFER NOT TO SAY □ MARITAL STATUS SINGLE □ MARRIED/CIVIL PARTNERSHIP □ CO-HABITATING □ OTHER □ PREFER NOT TO SAY □ DISABILITY Do you consider that you have a disability? YES □ NO □ PREFER NOT TO SAY □ If YES, please give brief details of the disability and any adjustments which would need to be made to enable you to carry out the duties listed for this post (continue on a separate sheet if necessary). RACE Please make sure that you read all the categories and then tick the box that applies to you. White: BRITISH □ IRISH □ ANY OTHER WHITE BACKGROUND □ (please specify): Mixed race: WHITE AND BLACK CARIBBEAN □ WHITE AND BLACK AFRICAN □ WHITE AND ASIAN □ ANY OTHER MIXED BACKGROUND □ ( please specify): Asian or Asian British: INDIAN □ PAKISTANI □ BANGLADESHI □ ANY OTHER ASIAN BACKGROUND □(please specify): Black or Black British: CARIBBEAN □ AFRICAN □ ANY OTHER BLACK BACKGROUND □ Chinese or ethnic: CHINESE □ ANY OTHER □ (please specify):Prefer not to say: □ SEXUAL ORIENTATION LESBIAN/GAY □ BI-SEXUAL □ HETEROSEXUAL □ PREFER NOT TO SAY □ RELIGION CHRISTIAN (including Church of England/Scotland/Ireland, Catholic, Protestant and all other Christian denominations) □ BUDDHIST □ HINDU □ JEWISH □ MUSLIM □ SIKH □ ANY OTHER RELIGION □ (please specify): PREFER NOT TO SAY □