Single Married or in a Civil Partnership Divorced Widowed 4. Caring Responsibilities in your Personal Life Are you responsible for looking after children under the age of 16? (Please tick appropriate box) Yes No Are you responsible for helping any other person carry out their daily routine? (Please tick appropriate box) Yes No 5. Language(s) Spoken English Other First language learnt Main language used now If please write in 6. Sexual Orientation Person of the same sex (lesbian or gay man) Persons of opposite sex (heterosexual) Persons of the same sex and opposite sex (bisexual) Prefer not to disclose 7. Which religion/belief do you follow? Buddhism Judaism Christianity Sikhism Hinduism Other religion, please write in _________ Islam None Prefer not to disclose 8. Ethnic Origin What is Ethnic Origin? Please tick the box that you believe best described your ethnic origin. Your ethnic origin is not related to your nationality, place of birth, or citizenship. It describes your culture and broad ethnic group. UK citizens can belong to any of the groups indicated below. What would you describe to be your ethnic origin? (Please tick appropriate box) White British Irish Traveller of Irish Heritage Gypsy/Roma Any other White background, please write in ___________ White and Black Caribbean White and Black African and Asian Any other Mixed background, please write in ___________ Asian or Asian British Indian Pakistani
Single Married or in a Civil Partnership Divorced Widowed 4. Caring Responsibilities in your Personal Life Are you responsible for looking after children under the age of 16? (Please tick appropriate box) Yes No Are you responsible for helping any other person carry out their daily routine? (Please tick appropriate box) Yes No 5. Language(s) Spoken English Other First language learnt Main language used now If please write in 6. Sexual Orientation Person of the same sex (lesbian or gay man) Persons of opposite sex (heterosexual) Persons of the same sex and opposite sex (bisexual) Prefer not to disclose 7. Which religion/belief do you follow? Buddhism Judaism Christianity Sikhism Hinduism Other religion, please write in _________ Islam None Prefer not to disclose 8. Ethnic Origin What is Ethnic Origin? Please tick the box that you believe best described your ethnic origin. Your ethnic origin is not related to your nationality, place of birth, or citizenship. It describes your culture and broad ethnic group. UK citizens can belong to any of the groups indicated below. What would you describe to be your ethnic origin? (Please tick appropriate box) White British Irish Traveller of Irish Heritage Gypsy/Roma Any other White background, please write in ___________ White and Black Caribbean White and Black African and Asian Any other Mixed background, please write in ___________ Asian or Asian British Indian Pakistani