www.companychameleon.com

#10yearsChameleon

Equal Opportunities Form

In order to monitor the effectiveness of our equal opportunities policy, it is important to collect information which might identify possible direct and indirect barriers to inclusion. In line with our commitment, any information provided is entirely confidential, and is NOT part of any selection procedure.

How did you find out about the job opportunity with Company

Chameleon? Please tick as many as apply.

website Whose:

flier/poster Where:

email From:

social media From:

verbally/word-of-mouth From:

other What:

prefer not to say

www.companychameleon.com

#10yearsChameleon

Personal Information – if you prefer not to answer any question, please indicate.

Please describe your gender:

prefer not to say

Your sexual orientation:

prefer not to say

Your age:

prefer not to say

Your full home postcode:

prefer not to say

Your ethnicity/cultural background:

prefer not to say

Do you consider yourself to be a disabled person? NO YES

prefer not to say

The Disability Discrimination Act (1995) defines a disabled person as someone with a

physical or mental impairment which has a substantial & long-term adverse effect on

their ability to carry out day-to-day activities.

Do you have dependants? NO YES

prefer not to say

Dependants can include children, the elderly, or others who rely on you for care.

Thank you.