□ □ □ British / English / / Indian White & Black Caribbean Scottish / Northern Irish Irish □ Pakistani □ & Black African □ □ □ □ Other* Bangladeshi White & Asian □ □ □ Gypsy or Irish Traveller Chinese Other* Black / African / Caribbean / *If please state: □ ‘Other’ Black British: African □ Ethnic Group: □ □ Caribbean Arab Prefer not to answer □ Any Other* □ □ Religion: □ □ □ Buddhist Muslim None □ □ □ Hindu Sikh Other □ □ Jewish Christian (including Church of England, Catholic, If other please state: Protestant and all other Christian denominations) □ Prefer not to answer Marital Status: □ □ □ Single Co-habiting Married □ □ □ Separated Divorced Prefer not to answer Transgender: Do you now present full or part time in a gender role that differs from the gender assigned to you at birth? □ □ □ Yes No Prefer not to answer where did you hear of this vacancy: – □ Website Please state which website: □ Word of mouth Please state who: □ Press advert Please state which publication: □ Agency Please state which agency: □ Other Please provide detail: I declare that the information given on this form is, to the best of my knowledge, complete and correct and I understand that any false information or failure to disclose criminal activities will result in dismissal or disciplinary action if appointed. Date:_______________________________
British / English / / Scottish / Northern Irish □ Indian □ White & Black Caribbean □ Irish □ Pakistani □ & Black African □ Other* □ Bangladeshi □ White & Asian □ Gypsy or Irish Traveller □ Chinese □ Other* □ Black / African / Caribbean / Black British: □ *If ‘Other’ please state: African □ Ethnic Group: Caribbean □ Arab □ □ Any Other* □ Prefer not to answer □ Religion: Buddhist □ Muslim □ None □ Hindu □ Sikh □ Other □ Jewish □ Christian (including Church of England, Catholic, Protestant and all other Christian denominations) □ If other please state: Prefer not to answer □ Marital Status: Single □ Co-habiting □ Married □ Separated □ Divorced □ Prefer not to answer □ Transgender: Do you now present full or part time in a gender role that differs from the gender assigned to you at birth? Yes □ No □ Prefer not to answer □ – where did you hear of this vacancy: Website □ Please state which website: Word of mouth □ Please state who: Press advert □ Please state which publication: Agency □ Please state which agency: Other □ Please provide detail: I declare that the information given on this form is, to the best of my knowledge, complete and correct and I understand that any false information or failure to disclose criminal activities will result in dismissal or disciplinary action if appointed. Date:_______________________________
Clerk-and-Governance-Advisor.docx