Baha’i Rastafarian □ □ Buddhist Sikh □ □ Christian Zoroastrian □ □ Hindu Humanist □ □ Jainist Atheist □ □ Jewish Agnostic □ □ Muslim Other (please specify) □ □ Sexual orientation: (Please tick) Lesbian Bisexual □ □ Gay Heterosexual □ □ Prefer not to say □ Which of the following best describes your circumstances? (please tick) Married Cohabiting □ □ Civil Partnership Single □ □ Dependents: If you are female, are you pregnant or have you had a child in the last year? Yes No □ □ Do you have children under 16? Yes No □ □ Do you have parents or other adults who depend on you for daily care? Yes No □ □ Disability: Do you have a condition covered by the disability discrimination act? Yes No □ □ If the answer is yes, please describe your disability briefly and any adjustments you might need to do this job. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
□ Baha’i □ Buddhist □ Christian □ Hindu □ Jainist □ Jewish □ Muslim □ Rastafarian □ Sikh □ Zoroastrian □ Humanist □ Atheist □ Agnostic □ Other (please specify) Sexual orientation: (Please tick) □ Lesbian □ Gay □ Bisexual □ Heterosexual □ Prefer not to say Which of the following best describes your circumstances? (please tick) □ Married □ Civil Partnership □ Cohabiting □ Single Dependents: If you are female, are you pregnant or have you had a child in the last year? □ Yes □ No Do you have children under 16? □ Yes □ No Do you have parents or other adults who depend on you for daily care? □ Yes □ No Disability: Do you have a condition covered by the disability discrimination act? □ Yes □ No If the answer is yes, please describe your disability briefly and any adjustments you might need to do this job. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
Support%20worker%20APPLICATION%20FORM.docx