Name or initials: Sexual orientation (please tick) Are you? Heterosexual: Lesbian: Gay: Bisexual: Do not wish to disclose: Transgendered (please tick) Are you Transgendered/Transsexual? Yes: No: Do not wish to disclose: Ethnic group (please tick) WHITE MIXED British: White and Black Caribbean: Irish: White and Black African: White and Asian: Other:1 Please specify: Any other Mixed background: Please specify: BLACK OR BLACK BRITISH ASIAN OR ASIAN BRITISH Caribbean: Indian: African:2 Pakistani: Bangladeshi: Please specify: Any other Black background: Any other Asian background: Please specify: Please specify: CHINESE AND OTHER Chinese: Do not wish to disclose: Any other background:3 Please specify: 1. Turkish, Turkish Cypriot, Traveller of Irish Heritage, Albanian, Greek/Greek Cypriot, Gypsy/Roma, White Western European, White Eastern European, any other White. 2. Angolan, Congolese, Ghanaian, Nigerian Sierra Leonean, Somali, Sudanese, any other Black African. 3. Afghan, Kurdish, Latin/South/Central American, Vietnamese, any other ethnic group. Language (please tick) Language Fluency (Mother Tongue or qualified fluency etc) Is this your first Language? Mother Tongue Fluency (Qualified) Other Mother Tongue Fluency (Qualified) Other Mother Tongue Fluency (Qualified) Other
Name or initials: Sexual orientation (please tick) Are you? Heterosexual: Lesbian: Gay: Bisexual: Do not wish to disclose: Transgendered (please tick) Are you Transgendered/Transsexual? Yes: No: Do not wish to disclose: Ethnic group (please tick) WHITE British: Irish: Other:1 Please specify: MIXED White and Black Caribbean: White and Black African: White and Asian: Any other Mixed background: Please specify: BLACK OR BLACK BRITISH Caribbean: African:2 Please specify: Any other Black background: Please specify: ASIAN OR ASIAN BRITISH Indian: Pakistani: Bangladeshi: Any other Asian background: Please specify: CHINESE AND OTHER Chinese: Any other background:3 Please specify: Do not wish to disclose: 1. Turkish, Turkish Cypriot, Traveller of Irish Heritage, Albanian, Greek/Greek Cypriot, Gypsy/Roma, White Western European, White Eastern European, any other White. 2. Angolan, Congolese, Ghanaian, Nigerian Sierra Leonean, Somali, Sudanese, any other Black African. 3. Afghan, Kurdish, Latin/South/Central American, Vietnamese, any other ethnic group. Language (please tick) Language Fluency (Mother Tongue or qualified fluency etc) Is this your first Language? Mother Tongue Fluency (Qualified) Other Mother Tongue Fluency (Qualified) Other Mother Tongue Fluency (Qualified) Other
PA_Application_Form_Leadership.docx