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ETHNIC MONITORING and ASSISTANCE QUESTIONNAIRE FOR POSITIONS ON FOOD STANDARDS AGENCY ADVISORY COMMITTEES

Position applied for:Chair Member Both

MEMBERSHIP OF COMMITTEE ON ADVISORY COMMITTEE ON NOVEL FOODS AND PROCESSES

The Government has a policy of equality of opportunity for those wishing to serve in public appointments. That means that applications are welcome from all suitable individuals irrespective of, for example, race, gender or disability. In order to ensure that this policy is being complied with, applicants are asked to complete the questions below. This information will be used for statistical purposes only and it will be presented in the form of totals from which individuals cannot be separately identified.

Date of Birth Age

Gender:MaleFemale

Disability:

Do you consider yourself disabled?Yes

If so,please complete the assistance questionnaire

Advertising

Howdid you hear of this vacancy?

FSA websiteFSA NewsNature: British Medical Journal

The Guardian Other

Please give description:

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ASSISTANCE FOR INTERVIEW AND PERFORMANCE IN POST

To ensure we do not create any barriers in our selection process and to help us implement our equal opportunities policy effectively. Please let us know if you would like us to provide any particular assistance for your interview and, if appointed your performance in post, by answering the questions below.

Please tick below to show what assistance you would like for your interview:

Induction loop

Sign language interpreter (type: )

Keyboard for written tests (if applicable)

Someone with you at the interview (eg speech facilitator)

Car parking

Assistance in and out of a vehicle

Wheelchair access

Other assistance (please specify)

Please describe any special arrangements that would help you carry out public appointment duties

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Which groups do you most identify with? Please tick only ONE box incolumn AandONE box in column B (The options are listed alphabetically).

Column A
/
Column B
ASIAN
(A) / British or Mixed British / (A) / Bangladeshi
(B) / English / (B) / Indian
(C) / Irish / (C) / Pakistani
(D) / Scottish / (D) / Any other Asian background (specify if you wish)
(E) / Welsh
(F) / Or any other? (specify if you wish)
BLACK
(E) / African
(F) / Caribbean
(G) / Any other Black background (specify if you wish)
CHINESE
(H) / Any Chinese background (specify if you wish)
MIXED ETHNIC BACKGROUND
(I) / Asian and White
(J) / Black African and White
(K) / Black Caribbean and White
(L) / Any other Mixed ethnic background
(specify if you wish)

WHITE

(M) / Any White background (specify if you wish)
ANY OTHER ETHNIC BACKGROUND
(N) / Any other ethnic background (specify if you wish)

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