Peckham Digital Equal Opportunities Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Peckham Digital is committed to ensuring that all open call applicants and members of staff are treated equally, without discrimination on the grounds of gender, sexual orientation, marital or civil partner status, gender reassignment, race, colour, nationality, ethnic or national origin, religion or belief, disability or age.

This form is intended to help us maintain equal opportunities best practice and identify barriers to workforce equality and diversity.

Please complete this form and return it with your application. The form will be separated from your application on receipt.

The information on this form will be used for monitoring purposes only and will play no part
in the selection process.
All questions are optional. You are not obliged to answer any of these questions but the more information you supply, the more effective our monitoring will be.

All information supplied will stay confidential, and be stored securely.

Thank you for your assistance.

Gender - Please choose the option that best describes your gender:

Male (including trans men)

Female (including trans women)

Non-binary

Prefer not to say

Other:

Clear selection

Is your gender identity the same as the sex you were assigned at birth?

Yes

Prefer not to say

Clear selection

Age

18 - 19

20 - 34

35 - 44

45 - 54

55 - 64

65 - 74

75+

Prefer not to say

Clear selection

Ethnicity - Please choose the option that best describes your ethnic group or background:

White - British/English/Welsh/Scottish/Northern Irish

White - Irish

White - Gypsy or Irish traveller

Any other white background (please use other below)

Mixed/Multiple Ethnic Group

Mixed/Multiple - White/Black Caribbean

Mixed/Multiple - White/Black African

Mixed/Multiple - White/Asian

Any other mixed or multiple ethnic background (please use other below)

Black or Black British Caribbean

Black or Black British African

Any other Black or Black British background (please use other below)

Asian or Asian British Indian

Asian or Asian British Pakistani

Asian or Asian British Bangladeshi

Asian or Asian British Chinese

Any other Asian or Asian British background

Arab

Latin American

Prefer not to say

Other:

Clear selection

Sexual Orientation - Please choose the option that best describes your sexual orientation:

Bisexual

Queer

Gay man

Gay woman/Lesbian

Heterosexual/Straight

Prefer not to say

Other:

Clear selection

Disability - Do you consider yourself to be disabled or with a long-term physical or mental health condition?

Yes

Prefer not to say

Clear selection

Can you provide further details?

Visual impairment

Hearing impairment

Physical disabilities

Cognitive or learning disabilities

Neurodivergent

Mental health condition

Other long term chronic condition

Prefer not to say

Clear selection

Socio-economic background - What type of school did you attend?

State school

Independent or fee-paying school

Attended school outside of the UK

Prefer not to say

Other:

Clear selection

Do either of your parents hold degrees?

Yes - both

Yes - one

Don't know

Prefer not to say

Other:

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms