A Diverse Workforce

Employee Self-Identification Survey

Please fill out the form below and press "Finish" to submit the information.

The questions marked in red are mandatory. All others are optional. If appropriate, you may identify in more than one designated group.

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Please indicate which of the following group(s) you would self-identify (you may self-identify in more than one group)...

1. ABORIGINAL PERSONS

For the purpose of this survey an Aboriginal person is a North American Indian or a member of a First Nation, a Métis, or Inuit. North American Indians or members of a First Nation include status, treaty or registered Indians, as well as non-status and non-registered Indians.

Do you consider yourself to be an Aboriginal person?

  • Yes
  • No

If YES, please check the group below which best applies to you:

  • North American Indian/First Nation
  • Inuit
  • Métis
  • Other (please specify)  

2. AFRICAN NOVA SCOTIAN AND RACIALLY VISIBLE PERSONS

For the purpose of this survey, African Nova Scotians are persons who identify themselves as indigenous black Nova Scotians and racial visibility is defined by race or colour only, not citizenship, place of birth, religion, language, or cultural background.

Based on this definition do you consider yourself to be a African Nova Scotian or racially visible person?

  • Yes
  • No

If YES, please check the group below which best applies to you:

  • African Nova Scotian
  • Other Black (e.g. African Canadian, African American, Caribbean, African)
  • East Asian (e.g. Chinese, Japanese, Korean)
  • South Asian (e.g. East Indian, Pakistani, Sri Lankan, Bangladeshi)
  • Southeast Asian (e.g. Burmese, Cambodian, Filipino, Laotian, Malaysian, Thai, Vietnamese)
  • West Asian/Arab (e.g. Arab, Armenian, Iranian, Israeli, Lebanese, Palestinian, Syrian, Turkish)
  • Latin, South or Central American
  • Pacific Islands (e.g. Fijian, Polynesian)
  • Other (please specify)  

3. PERSONS WITH DISABILITIES

For the purpose of this survey a person with a disability is an individual who, for the purposes of employment, identify themselves or believe that an employer or potential employer is likely to consider them to be disadvantaged due to a long-term or recurring physical, mental, sensory, psychiatric, or learning impairment.

Based on this definition do you consider yourself to be a person with a disability?

  • Yes
  • No

If YES, please check the group below which best applies to you:

  • Mobility Impairment (Limited in the ability to walk)
  • Agility Impairment (Limited in coordination and/or walk)
  • Visual Impairment (If glasses or contacts correct condition, do not include yourself in this category)
  • Hearing Impairment
  • Speech Impairment
  • Intellectual Impairment (e.g. Down's Syndrome)
  • Learning Disability (e.g. Dyslexia)
  • Mental Health Disability (e.g. Depression, Schizophrenia)
  • Other (e.g. Diabetes, Epilepsy, Heart Condition) please specify  

4. PERMISSION

Do you give your permission to use the information on this form for additional Human Resource Management purposes?

(e.g. follow-up surveys asking your advice on affirmative action issues or contacting you directly with information on Affirmative Action Initiatives)

  • Yes
  • No

THANK YOU FOR YOUR COOPERATION!