Gender Female Male Non-binary / European EU State Country:
Gender Identity (if not male or female) Trans
Transsexual Transgender Non-binary
Gender Neutral Androgyny Intersex
Cross Dresser Transvestite
Other, please describe: / European Other State Country:
What is your sexual orientation? / Other, please describe:
Heterosexual/straight Gay/lesbian
Bisexual Pan sexual Prefer not to say / Mixed / Multiple ethnic groups
Other, please describe: / White and Black Caribbean White and Black African
White and Black Asian White and Black Asian
Marital Status
Married Same sex marriage Civil Partnership
Other, please describe: / Any other mixed background, please describe:
Age 16–24 25–29 30–34 / Asian British
35–39 40–44 45–49
50–54 55–59 60–64 / Indian Pakistani Bangladeshi Chinese
65+ / Any other Asian background (please state country)
What is your religion or belief? / Asian
Buddhist Hindu Muslim
Sikh Jewish Christian / Indian Pakistani Bangladeshi Chinese
Prefer not to say / Any other Asian background (please state country)
Any other religion or belief, please describe: / Black British / African British / Caribbean British
No religion or belief, please describe: / African State Country:
Caribbean State Country:
Any other Black background State:
What is your ethnicity? / Black / African / Caribbean
Ethnic origin categories are not about nationality, place of birth or citizenship. They are about the group to which you as an individual perceive you belong. Please indicate your ethnic origin by ticking the appropriate box or self-define. / African State Country:
White / Caribbean State Country:
English Welsh Scottish
Northern Irish / Any other Black background State:
Irish Gypsy, Roma or Irish Traveller / Please indicate the first part of your postcode
ie: CV12, WV12, B13
DISABILITIES
Do you consider yourself to have a disability? Please indicate yes or no.
Please describe your disability so the Office can make appropriate provision.
Are you seeking an interview under the Guaranteed Interview Scheme? Please indicate yes or no
www.westmidlands-pcc.gov.uk
West Midlands Police and Crime Commissioner
Aqua House, 20 Lionel Street, Birmingham, West Midlands B3 1AQ
0121 626 6060
Equal Opportunities Monitoring – form 3 of 3 – Business Services Manager