1. Are you:
Male
Female
2. What is your age:
Under 25
25-34
35-40
41-49
50+
3. Which of the following best describes you (please complete one box in both parts)
Part 1
Asian
Black
White
Other
If other please specify:
Part 2
African
Caribbean
European
Pakistani
Indian
Bangladeshi
Chinese
Other
If other please specify:
4. Are you:
a citizen of the UK
a citizen of another EC country
a citizen of another country
If another please specify:
5. Please indicate your status:
single
separated
widowed
divorced
married
living with partner
6. Do you have any children (under 18 years of age) living at home with you?
Yes
No
7. Do you have any elderly or disabled relatives living with you who are not fully able to care for themselves?
Yes
No
8. Would you describe yourself as having a disability?
Yes
No
If ‘yes’, please indicate the description which best describes your disability. Please complete more than one box if necessary.
Visual
Hearing
Co-ordination, dexterity or mobility
Mental Health
Learning Difficulty
Other
If other please specify:
9. Are you registered disabled?
Yes
No
10. Where did you hear about this vacancy?
11. Which trade publications (if any) do you read regularly?
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