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• Full name✱
• Pronouns
  He/him
  She/her
  They/them
  Xe/xem
  Ze/hir
  Ey/em
  Hir/hir
  Fae/faer
  Hu/hu

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  • Use name only

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  • Custom

  Let the employer know what pronouns you use so that they can address you correctly.

• Email✱
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• Current company

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Demographic Survey for SafetyCulture

We invite you to complete this optional survey to help us evaluate our diversity and inclusion efforts. Submission of the information on this form is strictly voluntary and refusal to provide it will not subject you to any adverse treatment or affect your job application. Information obtained will be kept separate from your name or job application. This information will be kept secure and confidential and will be used solely to evaluate our diversity and inclusion efforts.

• What is your age range?
  • 17 or younger
  • 18-20
  • 21-29
  • 30-39
  • 40-49
  • 50-59
  • 60 or older
• I identify my ethnicity as

  Select all that apply

  • White / Caucasian
  • Hispanic, Latino, or Spanish origin
  • Black or African American
  • Asian
  • Native Hawaiian or other Pacific Islander
  • Indigenous Peoples, First Nations, Native American, or Alaska Native
  • Middle Eastern or North African
  • Other race, ethnicity, or origin
• Which of the following most accurately describes(s) you?
  • Female
  • Male
  • Non-binary
  • Transgender
  • Intersex
  • I prefer not to say