St Clare HospiceEqual Opportunities Form

Equal Opportunities Form

Position applied for

Name

First Last

Age

Gender

Choose as many terms as apply to you

Male

Female

Transgender

Non-binary

Intersex

Prefer not to say

Other term (please specify)

Preferred gender term

If your preferred gender term was not listed above, please feel free to type it here.

Disability - do you have a disability?

Sexual orientation

Preferred sexual orientation term

If your preferred sexual orientation term was not listed above, feel free to type it here.

Ethinicity

Religion or belief

Preferred religious term

If your preferred religious / belief term was not listed above, feel free to type it here.