Bisexual Gay woman/ lesbian Other ☐ ☐ ☐ Gay man Heterosexual/ straight Prefer not to say ☐ ☐ ☐ What is your religion/belief? Buddhist ☐ Christian Hindu Jewish ☐ ☐ ☐ Muslim Sikh Prefer not to say ☐ ☐ ☐ Other No religion ☐ ☐ Please specify any other religion or belief: What is your ethnicity? Asian or Asian British Irish ☐ Bangladeshi Gypsy or Irish Other ☐ ☐ Pakistani Traveller Arab ☐ ☐ Indian Any other White Any other ethnicity ☐ ☐ ☐ Chinese background Prefer not to say ☐ ☐ Any other Asian Dual background ☐ background Black or Black British White & Black ☐ African Caribbean ☐ Caribbean White & Black African ☐ ☐ White Any other Black White & Asian ☐ ☐ English/ ☐ background Any other dual Welsh/Scottish/ ☐ background Northern Irish/British Do you have dependent children aged 18 or under? Yes No Prefer not to say ☐ ☐ ☐ Do you have caring responsibilities, other than parenting? Yes No Prefer not to say ☐ ☐ ☐ What is your legal marital or same-sex civil partnership status? Married ☐ Divorced ☐ Widowed ☐ In a registered same-sex civil partnership ☐ Never married and never registered in a same-sex civil partnership ☐ Formerly in a same-sex civil partnership which is now legally dissolved ☐ Separated, but still legally married ☐ Separated, but still legally in a same-sex civil partnership ☐ Surviving partner from a same-sex civil partnership ☐
☐ Bisexual ☐ Gay man ☐ Gay woman/ lesbian ☐ Heterosexual/ straight ☐ Other ☐ Prefer not to say What is your religion/belief? ☐ Buddhist ☐ Jewish ☐ Prefer not to say ☐ Christian ☐ Muslim ☐ Other ☐ Hindu ☐ Sikh ☐ No religion Please specify any other religion or belief: What is your ethnicity? Asian or Asian British ☐ Bangladeshi ☐ Pakistani ☐ Indian ☐ Chinese ☐ Any other Asian background White ☐ English/ Welsh/Scottish/ Northern Irish/British ☐ Irish ☐ Gypsy or Irish Traveller ☐ Any other White background Black or Black British ☐ African ☐ Caribbean ☐ Any other Black background Other ☐ Arab ☐ Any other ethnicity ☐ Prefer not to say Dual background ☐ White & Black Caribbean ☐ White & Black African ☐ White & Asian ☐ Any other dual background Do you have dependent children aged 18 or under? ☐ Yes ☐ No ☐ Prefer not to say Do you have caring responsibilities, other than parenting? ☐ Yes ☐ No ☐ Prefer not to say What is your legal marital or same-sex civil partnership status? ☐ Married ☐ Divorced ☐ Widowed ☐ In a registered same-sex civil partnership ☐ Never married and never registered in a same-sex civil partnership ☐ Formerly in a same-sex civil partnership which is now legally dissolved ☐ Separated, but still legally married ☐ Separated, but still legally in a same-sex civil partnership ☐ Surviving partner from a same-sex civil partnership
brent-works-equality-information-form-final.docx