DO YOU HAVE CHILDREN RESPONSIBILITY FOR ELDERLY DEPENDANTS (e.g. children, OTHER elderly, or any other person for NOT APPLICABLE whom you are the main carer)? DISABILITY Do you consider yourself to Yes No (please tick/double click to select) have a physical and/or mental impairment as defined by the Please give details if you wish: Equality Act 2010/ Disability Discrimination Act 1995 (NI)? ETHNIC ORIGIN WHITE: How would you describe your BRITISH identity? ENGLISH IRISH SCOTTISH WELSH OTHER (PLEASE SPECIFY): _____________________________ MIXED: WHITE AND BLACK CARIBBEAN WHITE AND BLACK AFRICAN WHITE AND ASIAN OTHER (PLEASE SPECIFY): _____________________________ ASIAN, ASIAN BRITISH, ASIAN ENGLISH, ASIAN SCOTTISH ASIAN IRISH OR ASIAN WELSH (Delete as applicable): INDIAN PAKISTANI BANGLADESHI (PLEASE SPECIFY): _____________________________ BLACK, BLACK BRITISH, BLACK ENGLISH, BLACK SCOTTISH, BLACK IRISH, BLACK WELSH (Delete as applicable): CARIBBEAN AFRICAN (PLEASE SPECIFY): _____________________________ CHINESE, CHINESE BRITISH, CHINESE ENGLISH, CHINESE SCOTTISH, CHINESE IRISH, CHINESE WELSH (Delete as applicable): CHINESE OTHER (PLEASE SPECIFY): _____________________________ OTHER ETHNIC ORIGIN: (PLEASE SPECIFY): ____________________________________ RELIGION/CULTURAL BACKGROUND NONE CHRISTIAN BUDDHIST HINDU
DO YOU HAVE RESPONSIBILITY FOR DEPENDANTS (e.g. children, elderly, or any other person for whom you are the main carer)? CHILDREN ELDERLY OTHER NOT APPLICABLE DISABILITY Do you consider yourself to have a physical and/or mental impairment as defined by the Equality Act 2010/ Disability Discrimination Act 1995 (NI)? Yes No (please tick/double click to select) Please give details if you wish: ETHNIC ORIGIN How would you describe your identity? WHITE: BRITISH ENGLISH IRISH SCOTTISH WELSH OTHER (PLEASE SPECIFY): _____________________________ MIXED: WHITE AND BLACK CARIBBEAN WHITE AND BLACK AFRICAN WHITE AND ASIAN OTHER (PLEASE SPECIFY): _____________________________ ASIAN, ASIAN BRITISH, ASIAN ENGLISH, ASIAN SCOTTISH ASIAN IRISH OR ASIAN WELSH (Delete as applicable): INDIAN PAKISTANI BANGLADESHI (PLEASE SPECIFY): _____________________________ BLACK, BLACK BRITISH, BLACK ENGLISH, BLACK SCOTTISH, BLACK IRISH, BLACK WELSH (Delete as applicable): CARIBBEAN AFRICAN (PLEASE SPECIFY): _____________________________ CHINESE, CHINESE BRITISH, CHINESE ENGLISH, CHINESE SCOTTISH, CHINESE IRISH, CHINESE WELSH (Delete as applicable): CHINESE OTHER (PLEASE SPECIFY): _____________________________ OTHER ETHNIC ORIGIN: (PLEASE SPECIFY): ____________________________________ RELIGION/CULTURAL BACKGROUND NONE CHRISTIAN BUDDHIST HINDU
Application-Pack-Green-Lanes-for-Bumblebees-Project-Trainee-2018-1.docx