Equality and Diversity Monitoring Form
Completing this form will help Glasgow North West Citizens Advice Bureau monitor equality and diversity statistics. This information is not part of your application and will not be used in any part of the selection process. The information will be stored anonymously and confidentially.
Position applying for:
*
Please Select
Welfare Outreach Adviser (GP Practices)
Gender
Which one of the following best describes your gender?
*
Male
Female
Prefer not to say
Prefer to self-describe
If you prefer to self-describe, please use the box below:
Is your gender identity the same as the sex you were assigned with at birth?
Yes
No
Prefer not to say
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Sexual Orientation
Which of the following best describes your sexual orientation?
*
Bisexual
Gay man
Gay Woman/Lesbian
Heterosexual/Straight
Prefer not to say
Prefer to self-describe
If you prefer to self-describe, please use the box below:
Disability
Do you consider yourself to be disabled?
*
Yes
No
Prefer not to say
Age
Please select from below:
16-24
25-34
35-44
45-54
55-65
65 +
Prefer not to say
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Ethnicity
Please tick the box for the group to which you perceive you belong:
*
Arab
Asian/Asian British: Indian
Asian/Asian British: Pakistani
Asian/Asian British: Bangladeshi
Asian/Asian British: Chinese
Black/Black British: African
Black/Black British: Caribbean
Mixed: White and Black Caribbean
Mixed: White and Black African
Mixed: White and Asian
White: British
White: Irish
White: Gypsy or Irish Traveler
Other
If you selected other, please specify below:
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Next
Religion and Belief
Please select from below:
Buddhist
Christian
Hindu
Jewish
Muslim
Non-religious
Sikh
Prefer not to say
Other
If you selected other, please specify below:
Submit
Should be Empty: