EQUAL OPPORTUNITIES IN EMPLOYMENT

Cheek by Jowl has an equal opportunities policy for recruitment and employment and welcomes applications from all sections of the community. This form is to ensure that our equal opportunities process is working effectively. Please circle the appropriate word.

GENDER Male Female Other Prefer not to say

ETHNIC ORIGIN

White British Irish

White – other (please specify): .........................................

Asian/British Asian Indian Pakistani Bangladeshi Chinese Vietnamese

Asian – other (please specify): .........................................

Black/Black British African Caribbean

Black – other (please specify): .........................................

Mixed White & Black Caribbean White & Black African White & Asian

Mixed – other (please specify): ………………………………………….

Other Ethnic Origin (please specify): .........................................

AGE 16-25 26-34 35-50 50+

Prefer not to say

DISABILITY

Do you have a disability? Yes No

Are you registered disabled? Yes No

Do you have any dependants? Yes No