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Equal Opportunities Survey for IVC Evidensia

We invite you to complete this optional survey to help us evaluate our diversity and inclusion efforts. Submission of the information on this form is strictly voluntary and refusal to provide it will not subject you to any adverse treatment or affect your job application. Information obtained will be kept separate from your name or job application. This information will be kept secure and confidential and will be used solely to evaluate our diversity and inclusion efforts.

• What is your age range?
  • 17 or younger
  • 18-20
  • 21-29
  • 30-39
  • 40-49
  • 50-59
  • 60 or older
  • Prefer not to say
• Do you consider yourself to have a disibility under the Equality Act 2010?
  • Yes
  • No
  • Prefer not to say
• If you answered yes above, please tick all options applicable below
  • Vision (eg due to blindness or partial sight)
  • Hearing (eg due to deafness or partial hearing)
  • Mobility, walking short distances, stairs, lifting heavy objects
  • Long standing illness
  • Mental health
  • Stamina or difficulty breathing
  • Social or behavioural ie: Autism, ADHD or Asperger's
  • Learning or concentrating, or memory
  • Other
  • Prefer not to say
• I identify my ethnicity as

  Select all that apply

  • White / Caucasian
  • Hispanic, Latino, or Spanish origin
  • Black or African American
  • Asian
  • Native Hawaiian or other Pacific Islander
  • Indigenous Peoples, First Nations, Native American, or Alaska Native
  • Middle Eastern or North African
  • Some other race, ethnicity, or origin
  • Prefer not to say
• What is your gender?
  • Female
  • Male
  • Other
  • Prefer not to say
• What gender do you identify as?
  • Female
  • Male
  • Non-binary
  • Prefer not to say
• What is your religion of belief?
  • No religion
  • Christian
  • Muslim
  • Hindu
  • Sikh
  • Jewish
  • Buddhist
  • Other
  • Prefer not to say
• How would you describe your sexual orientation?
  • Heterosexual / Straight
  • Gay or Lesbian
  • Bisexual
  • Other
  • Prefer not to say
• Do you have any caring responsibilities?
  • Yes
  • No
  • Prefer not to say

• • Yes, IVC Evidensia can contact me about future job opportunities for up to 2 years
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