Job Ref: ……………………………………….                  App Code: …………….

1

A. White                                             1  British  2 Irish         3 Other

B. Mixed                                            4  White & Black Caribbean   

5  White & Black African                                     6  White Asian              7   Other

C. Asian or British Asian              8  Indian                                                                                                                           9   Pakistani                                                                                                                    10  Bangladeshi                        11  Other  

D. Black or Black British              12  Caribbean                                                                                                                 13  African             14  Other

E. Chinese or Other Ethnic groups       15  Chinese          16  Other

F. Refused                                                    17 

2.

DISABLED                                                   

NOT DISABLED                                              

3.

Are you         Female          ‰            Male               ‰

Where did you see this position advertised:

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