DEMOGRAPHICS CONSENT FORM
Pekarsky & Co is committed to
matching exceptional candidates
with exceptional organizations.
To help
organizations meet their
commitments to diversity and
inclusion, candidates may wish
to provide
certain demographic information
about themselves, including
their gender, sexual
orientation, ethnicity,
place of birth, and/or
disability status.
We only collect this information on
behalf of clients requesting
this information be collected
and
reported:
if you consent to the
collection, use, and
disclosure of such
information for this
purpose; and
on the understanding that
organizations will use
this information in
accordance with
applicable
human rights and privacy
legislation.
Completion of this demographic
survey is entirely voluntary and
done on a self-identification
basis. If
you choose to complete the survey,
each of the questions is
optional – you may choose to
respond to
all, or some of the questions.
If for any reason you do not
wish to respond to the survey,
please select
that option below.
If you have any questions about this
survey or how your personal
information is used by Pekarsky
& Co,
please review our Privacy Policy
https://pekarskyco.com/privacy-policy/
or contact our Privacy Officer
at
[email protected] .
DEMOGRAPHICS SURVEY -
RESPONSES
Gender:
How do you
identify?
Gender-Fluid
and/or
Non-Binary
Male
Transgender
Two-Spirit
Female
Another Gender
Identity (I wish
to specify):
Another Gender
Identity (I do
not wish to
specify)
I Prefer Not to Respond
Sexual Orientation:
How do you identify?
Asexual
Bisexual
Gay
Heterosexual
Lesbian
Queer
Two-Spirit
Another Orientation (I wish to specify):
Another Orientation (I do not wish to specify)
I Prefer Not to Respond
Indigenous /
Aboriginal
Peoples::
Do you identify as
an
Indigenous/Aboriginal
person, which
includes: First
Nations (status
or non-status),
Métis or Inuk
(Inuit) within
Canada, or as an
Indigenous
person from
outside of
Canada?
Yes
No
Another Response:
I Prefer Not to Respond
If you answered
Yes above,
please indicate
which apply to
you (choose one,
many, or none of
the below
responses):
First Nations (within Canada)
Inuk (Inuit) (within Canada)
Métis (within Canada)
Indigenous /
Aboriginal from
North America
but outside of
Canada
Indigenous /
Aboriginal from
outside of North
America
Another (I wish
to specify):
Another (I do
not wish to
specify)
I Prefer Not to Respond
Member of a
Visible
Minority
Canada’s
Employment
Equity Act
defines a
“member of
visible
minority” as a
person other
than
Indigenous/Aboriginal
peoples, who are
non-Caucasian in
race or
non-white in
colour.
Do you identify
as:
Indigenous / Aboriginal
White
Visible Minority
I Prefer Not to Respond
Please indicate which apply to you (choose one, many, or none of the below responses):
White
South Asian (e.g., East Indian, Pakistani, Sri Lankan)
Chinese
Black
Filipino
Arab
Latin American
Southeast Asian (e.g., Vietnamese, Cambodian, Laotian, Thai)
West Asian (e.g., Iranian, Afghan)
Korean
Japanese
Another (I wish to specify):
Another (I do not wish to specify)
I Prefer Not to Respond
Country of Birth
Where were you born?
Canada
Outside of Canada (I wish to specify):
Outside of Canada (I do not wish to specify)
I Prefer Not to Respond
Disability
How do you identify?
A Person with a Disability
A Person Without a Disability
Another Response:
I Prefer Not to Respond