Please enable JavaScript in your browser to complete this form.Major Healthcare wants to meet the aims and commitments set out in its equality policy. This includes not discriminating under the Equality Act 2010, and building an accurate picture of the make-up of the workforce in encouraging equality and diversity. The organisation needs your help and co-operation to enable to do this, but filling in this form is voluntary. The information you provide will stay confidential, and be stored securely and limited to only some staff in the organisation’s Human Resources section. Please select your nearest branch * Doncaster Healthcare (DNCH)Midlands Healthcare (MIHC)North East Healthcare (NOEH)Yorkshire & East Midlands Healthcare (YEMH)Name *FirstLastGender MaleFemalePrefer not to say current your to Are you married or in a civil partnership? MarriedIn a civil partnershipSingleDivorcedWidowedPrefer not to sayAge 16-2425-2930-3435-3940-4445-4950-5455-5960-6465+Prefer not to sayWhat is your ethnicity?Ethnic origin is not about nationality, place of birth, or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box. WhiteEnglishWelshScottishNorthern IrishIrishBritishGypsy/Irish TravellerPrefer not to sayAny other white background please detailMixed/Multiple Ethnic GroupsWhite and Black CaribbeanWhite and Black AfricanWhite and AsianPrefer not to sayAny other mixed/multiple ethnic background please detailAsian/Asian BritishIndianPakistaniBangladeshiChineseArabPrefer not to sayAny other Asian background please detailBlack/African/Caribbean/Black BritishAfricanCaribbeanPrefer not to sayAny other Black/African/Caribbean background (please detail)Any other ethnic group (please detail) Do you consider yourself to have a disability or health condition? YesNoPrefer not to sayWhat is the effect or impact of your disability or health condition on your ability to give your best at work? Please detail below:The information on this form is for monitoring purposes only. If you believe you need a ‘reasonable adjustment’, then please discuss this with your manager, or the manager running the recruitment process if you are a job applicant.What is your sexual orientation? HeterosexualGay woman/LesbianGay manBisexualPrefer not to sayOtherOther sexual orientationWhat is your religion or belief? No religion or beliefBuddhistChristianHinduJewishMuslimSikhPrefer not to sayOtherOther religion or beliefWhat is your current working pattern? Full-timePart-timePrefer not to sayWhat is your flexible working arrangement? NoneFlexi-timeStaggered hoursTerm-time hoursFlexible shiftsAnnualised hoursJob-shareCompressed hoursHome workingPrefer not to sayDo you have caring responsibilities? If yes, tick all that apply:NonePrimary carer of children under 18Primary carer of disabled adult 18+Primary carer of older personSecondary carer (another person carries out the main caretaking role)Prefer not to saySubmit