Monitoring Form

Reference Number Label

Reference Number: UC-260722-2528

Question 1

We are an Equal Opportunities Employer.

In accordance with the Fair Employment (Monitoring) Regulations (NI) 1999, indicate your community background by ticking the appropriate box below.

Community Background

Member of the Protestant Community

Member of the Roman Catholic Community

Member of neither the Protestant nor the Roman Catholic community

My Nationality is

Question 2

In asking this question, we want to assure applicants that the information provided will only be used to promote equality of opportunity for applicants and employees on the basis of their Nationality.

Question 3

Disability

Under the Disability Discrimination Act 1995 a person is considered to have a disability if he/she has a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities. Please note that it is the effect of the impairment, without treatment, which determines if an individual meets this definition of disability.

Do you consider that you meet this definition of disability?

Yes

If yes, please state the type of disability

Are there reasonable adjustments that we could make as part of our recruitment process?

How did you become aware of this vacancy?

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If there is any material inaccuracy in the above information, please inform me of the correct information within the next week so that account can be taken of it when preparing the monitoring return which I am required to send to the Equality Commission

Note:

It is a criminal offence under the legislation for a person to “give false information in connection with the preparation of the monitoring return”.