Document Sample
Client_Profile Powered By Docstoc
					   Milton Keynes Citizens Advice Bureau Service                                                     CLIENT REFERENCE NUMBER:

   HR Toolkit – Client Profile
Please complete this form b y placing a √ or an x in the appropriate b ox. The provision of this information is entirely volun tary
and, although it would b e helpful to Milton Keynes Citizens Advice Bureau for monitoring purposes, if you do not wish to
complete any section, please leave it b lank.

PLEASE NOTE: all responses will b e treated in the strictest confidence, and used solely for statistical purposes.

Certain information provided b y you on this form will constitute sensitive personal data under the Data Protection Act 1998.
By providing us with this information, you will be deemed to have explicitly consented to Milton Keynes Citizens Advice
Bureau using such information for the purposes identified on this form.

 Surname                                                                              Forename

 Title                                                                                Position
 Name of Company

 Business Address

 Business Tel No                                                                      Fax

 Email Address

 AGE RANGE OF EMPLOYEES                                                                                    NUMBER OF EMPLOYEES
   16 – 20         21 – 30                                               31 – 40                            Full Time: + 36 hrs
     41 – 50                              51 – 60                        61 – 65                             Part Time: 1-35 hrs
 DISABILITY: Under the definition in the 1995 Disability Discrimination Act please tick the age range of any
 employees that consider themselves disabled
     16 – 20                              21 – 30                        31 – 40                         61 – 64
   41 – 50            51 – 60                61 – 65                   65+
 ETHNIC GROUP: Please tick ALL appropriate boxes to indicat e the ethnic background of your employees.
 White                  British                                                Black or                  Caribbean

                        Irish                                                  Black                     African
                        Other white background                                                           Other black background

 Mixed                  White & Black Caribbean                                Asian or                  Indian

                        White & Black African                                  Asian                     Pakistani
                        White & Asian                                                                    Bangladeshi
                        Other mixed background                                                           Other Asian background

 Chinese                                                                       Other ethnic group
                                   Thank you for assi sting us by completing the Questionnaire

         Supported by
                                Company Limited by Guarantee: Registered No. 2265182 Registered Charity No. 800012
                                Registered Office: Acorn House, 361 Midsummer Boulev ard, Central Milton Key nes, MK9 3HP