Inclusion and Diversity Form

Inclusion and Diversity Form

Contact is committed to an inclusive, safe and supportive work environment.

To help Contact measure progress, please complete and return this form. The information is anonymous and separated from your application. It is strictly confidential and only used to provide an overall profile analysis of our work.

Please contact us at: if you require this form in another format.

Job/ opportunity title

Self Classification

I would describe my ethnic origin as:

Classification by ethnic origin

I would describe my ethnic origin as:

(Please tick)

Black or Black British / White
Black African / British
Black Caribbean / Irish
Any other Black background / Any other White background
Asian or Asian British / Mixed Heritage
Asian Bangladeshi / Asian and White
Asian Indian / Black African and White
Asian Pakistani / Black Caribbean and White
Any other Asian background / Chinese and White
Any other background
(from more than one background)
Chinese Origin / Any other ethnic group
Prefer not to say
Age Range
16-19 / 41-50
20-30 / 50 +
31-40 / Prefer not to say

Self-Classification

Classification of Sexual Orientation

I would describe my sexual orientation as:

(Please tick)

Sexual Orientation
Bisexual
Gay Man
Gay Woman/Lesbian
Heterosexual/Straight
Not known/prefer not to say

Classification of Disability

In terms of the following definition on provided by the Disability Discrimination Act (DDA), would you describe yourself as disabled in any way?

The Disability Discrimination Act 1995 (DDA) protects disabled people. The DDA defines a person as disabled if they have a physical or mental impairment, which has a substantial and long term (i.e. has lasted or is expected to last at least 12 months) and has an adverse effect on the person’s ability to carry out normal day-to-day activities.

Yes / No
Prefer not to say

Gender

Female / Male
Do you identify as transgender? / Prefer not to say

Where did you hear about the job/role/post?

Please tick box(es) as applicable:

The Guardian Newspaper / Contact foyer/noticeboard
Guardian Online / Arts Council England Arts Jobs
Caribbean Times / All About Audiences
Eastern Eye / Disability Advisory Service
University networks / Word of mouth
Contact Website / The Job Centre Plus
Other:
Website / please specify:
Mailing List / please specify:
Other e.g. arts/community organisation noticeboard / please specify:
Other publication / please specify: