16 - 24 years 49 - 56 years 25 - 33 57 - 65 years 34 - 40 years 66 - 70 years 41 - 48 years Over 70 years If you would prefer not to say please put x in the box 3 Religion and belief Christian Buddhist Hindu Jewish Muslim Sikh No religion Other If you would prefer not to say please put x in the box 4 Gender how would you describe your gender? – Male Female If you would prefer to use your own term please provide it here If you would prefer not to say please put x in the box 5 Gender identity - is your gender identity the same as the gender you were assigned at birth? Yes No If you would prefer not to say please put x in the box 6 Sexual orientation Heterosexual Gay man Gay woman/lesbian Bisexual If you prefer not to say please put x in the box 7 Do you consider yourself to be a person with a disability? Under the Equality Act 2010 a person is classified as disabled if they have a physical or mental impairment which has a substantial and long term effect on their ability to carry out normal day to day activities. Yes No If you prefer not to say please put x in the box 8 Are you a carer? A carer is anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support. Yes No If you would prefer not to say please put x in the box 9 Please tell us how you heard about this post. Peridot Partners Carers Trust Charity Other (please specify) website Job/Guardian/S1 you feel that our recruitment procedure has been unfair please tell us at If
16 - 24 years 49 - 56 years 25 - 33 57 - 65 years 34 - 40 years 66 - 70 years 41 - 48 years Over 70 years If you would prefer not to say please put x in the box 3 Religion and belief Christian Buddhist Hindu Jewish Muslim Sikh No religion Other If you would prefer not to say please put x in the box 4 Gender – how would you describe your gender? Male Female If you would prefer to use your own term please provide it here If you would prefer not to say please put x in the box 5 Gender identity - is your gender identity the same as the gender you were assigned at birth? Yes No If you would prefer not to say please put x in the box 6 Sexual orientation Heterosexual Gay man Gay woman/lesbian Bisexual If you prefer not to say please put x in the box 7 Do you consider yourself to be a person with a disability? Under the Equality Act 2010 a person is classified as disabled if they have a physical or mental impairment which has a substantial and long term effect on their ability to carry out normal day to day activities. Yes No If you prefer not to say please put x in the box 8 Are you a carer? A carer is anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support. Yes No If you would prefer not to say please put x in the box 9 Please tell us how you heard about this post. Peridot Partners Carers Trust website Charity Job/Guardian/S1 Other (please specify) If you feel that our recruitment procedure has been unfair please tell us at
Carers%20Trust%20Equal%20opportunities%20monitoring%20form.docx