First name:

Last name:

Yearly Salary:

Age:

Job Title:

Name of the company:

Number of years at the job:

Brief description of your role at the job:

Ethnicity:

Not Selected Caucasian West Asian Latin American Southeast Asian Arab Filipino African American Korean Japanese Chinese Visible minority, other Multiple visible minorities

Religious Affliation:

Not Selected Christian Muslim Hindu Sikh Buddhist Jewish No religious affliation Other

Gender:

Not Selected male female transgender gender neutral non-binary agender pangender genderqueer two-spirit third gender

Sexual Orientation

Not Selected heterosexual homosexual bisexual asexual
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