Date of birth: Nationality: How would you describe your ethnic origin? (tick one) White British Asian or Asian British - Indian Mixed and Black African – –White White Irish or Asian British - Pakistani Mixed and Asian – –White Other White background Asian or Asian British Bangladesh Mixed background – Gypsy or Traveller Chinese Arab Black or Black British - Caribbean Other Asian background Other Ethnic background Black or Black British - African Mixed and Black Caribbean Prefer not to say –White Other Black Background Do you consider yourself to have a disability or disabilities? (tick one or more) No known disability Specific learning disability (e.g. dyslexia or dyspraxia) General learning disability (e.g. Down’s syndrome) Cognitive impairment (e.g. autistic spectrum disorder or resulting from head injury) Long-standing illness or condition (e.g. cancer, HIV, diabetes, chronic heart disease, epilepsy) Mental health condition (e.g. depression or schizophrenia) Physical impairment or mobility (e.g. wheelchair / crutches / difficulty using arms) Deaf or serious hearing impairment Blind or serious visual impairment Other type of disability: ____________________________________________________________________ Prefer not to say If you require any arrangements to enable you to attend the Assessment Centre please call us on 0191 515 3000. What is your sexual orientation? (tick one) Bisexual Gay woman/lesbian Prefer not to say Gay man Heterosexual Other What is your religion? (tick one) No religion Jewish Any other religion or belief Buddhist Muslim Prefer not to say Christian Sikh Other Hindu Spiritual This is the end of Part 2 of the Application Form. Please ensure you also complete all sections in Part 1.
Date of birth: Nationality: How would you describe your ethnic origin? (tick one) White – British White – Irish Other White background Gypsy or Traveller Black or Black British - Caribbean Black or Black British - African Other Black Background Asian or Asian British - Indian or Asian British - Pakistani Asian or Asian British – Bangladesh Chinese Other Asian background Mixed –White and Black Caribbean Mixed –White and Black African Mixed –White and Asian Mixed background Arab Other Ethnic background Prefer not to say Do you consider yourself to have a disability or disabilities? (tick one or more) No known disability Specific learning disability (e.g. dyslexia or dyspraxia) General learning disability (e.g. Down’s syndrome) Cognitive impairment (e.g. autistic spectrum disorder or resulting from head injury) Long-standing illness or condition (e.g. cancer, HIV, diabetes, chronic heart disease, epilepsy) Mental health condition (e.g. depression or schizophrenia) Physical impairment or mobility (e.g. wheelchair / crutches / difficulty using arms) Deaf or serious hearing impairment Blind or serious visual impairment Other type of disability: ____________________________________________________________________ Prefer not to say If you require any arrangements to enable you to attend the Assessment Centre please call us on 0191 515 3000. What is your sexual orientation? (tick one) Bisexual Gay man Gay woman/lesbian Heterosexual Prefer not to say Other What is your religion? (tick one) No religion Buddhist Christian Hindu Jewish Muslim Sikh Spiritual Any other religion or belief Prefer not to say Other This is the end of Part 2 of the Application Form. Please ensure you also complete all sections in Part 1.
Application%20Form%20October%202018.docx