Department for Culture, Media and Sport
Monitoring Information - Part 2
Personal details
Surname:
Date of Birth:
Forename:
Gender:
Title:
Male
Female
Other
Do you consider yourself to have a transgender history?
Gender Identity
Yes
No
Prefer not to say
Disability
DCMS wishes to encourage suitably qualified people with disabilities to apply for positions. All information
will be treated in the strictest confidence.
Do you consider that you have a disability?
Yes
No
Prefer not to say
Ethnic Background
Which Ethnic Background do you most identify with? Please tick one box only.
Asian
Bangladeshi
Indian
Pakistani
Other Asian background (specify if you wish)
Black
Caribbean
African
Any other Black background (specify if you wish)
Chinese
Any Chinese background (specify if you wish)
Mixed Ethnic Background
Black African & White
Asian & White
Black Caribbean & White
Any other Mixed Ethnic background
(specify if you wish)
White
Any White background (specify if you wish)
Any Other Ethnic Background
(specify if you wish)
Prefer not to say
Religion or Belief
Which religion or belief do you most associate with? Please tick one box only.
No religion
Hindu
Sikh
Bahai
Jain
Other
Buddhist
Jewish
None or atheist
Christian
Muslim
Prefer not to say
Sexual Orientation
Which sexual orientation do you most associate with? Please tick one box only.
Bisexual
Gay Man
Gay Woman/Lesbian
Heterosexual/straight
Prefer not to say
Wider eligibility
I consent to being approached by other Government Departments about their public appointments