Gender: Male Female Prefer not to say
Are you married or in a civil partnership?: Yes No Prefer not to say
Age: —Please choose an option— 16-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Prefer not to say
What is your ethnicity?
White: —Please choose an option— English Welsh Scottish Northern Irish Irish British Gypsy or Irish Traveller Prefer not to say
Mixed/multiple ethnic groups: —Please choose an option— White and Black Caribbean White and Black African White and Asian Prefer not to say
Asian/Asian British: —Please choose an option— Indian Pakistani Bangladeshi Chinese Prefer not to say
Black/ African/ Caribbean/ Black British: —Please choose an option— African Caribbean Prefer not to say
Other ethnic group: —Please choose an option— Arab Prefer not to say
Do you consider yourself to have a disability or health condition? Yes No Prefer not to say
What is the effect or impact of your disability or health condition on your ability to give your best at work?
What is your sexual orientation? —Please choose an option— Heterosexual Gay woman/lesbian Gay man Bisexual Prefer not to say
What is your religion or belief? —Please choose an option— No religion or belief Buddhist Christian Hindu Jewish Muslim Sikh Prefer not to say
What is your current working pattern? —Please choose an option— Full-time Part-time Prefer not to say
What is your preferred flexible working arrangement? —Please choose an option— None Flexi-time Staggered hours Term-time hours Annualised hours Job-share Flexible shifts Compressed hours Homeworking Prefer not to say
Do you have caring responsibilities? (please tick all that apply)
No Primary carer of a child/children (under 18) Primary carer of disabled child/children Primary carer of disabled adult (18 and over) Primary carer of older person Secondary carer (another person carries out the main caring role) Prefer not to say
