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MONITORING FORM
To demonstrate the Digital Arts Studio’s commitment to equality of opportunity in employment we must monitor the community background of our employees and job applicants as required by the Fair Employment (Northern Ireland) Act 1989. We are asking you to help us by indicating below the community background to which you belong. (Please tick the appropriate box)
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* Indicates required question
In Confidence
Your Religious Belief
*
Protestant
Roman Catholic
Other Religious Faith: (please specify)
Not disclosed
Required
Your Marital Status
*
Single
Married
In a civil partnership
Separated
Divorced
Widowed
Required
Your Racial Group
*
White
Chinese
Irish Traveller
Pakistani
Bangladeshi
Black African
Black Caribbean
Black Other
Mixed Ethnic Group.
Other Ethnic Group.
Required
If Mixed or Other ethnic group please state which:
Your answer
My Nationality is:
*
Your answer
Age
*
16 - 21
22-30
31-40
41-50
51-60
61-64
65+
Required
My sexual orientation is towards someone
*
Of the same sex
A different sex
Both
Required
Dependants. Do you have responsibility for the care of:
*
A child/children?
A dependent elderly person?
A person with a disability?
No Caring Responsibilities
Required
Other. Please specify:
Your answer
Disability
The Disability Discrimination Act considers a person disabled if:• You have a long standing physical or mental condition or disability that has lasted or is likely to last at least 12 months, and• This condition or disability has a substantial adverse effect on your ability to carry out normal day-to-day activities.Do you consider yourself to be disabled as set out under the Disability Discrimination Act? (Please tick ‘Yes’ or ‘No’)
*
Yes
No
If YES please state the type of disability below:
Physical Impairment, such as difficulty using your arms or mobility issues which means using a wheelchair or crutches.
Sensory Impairment, such as being blind/having a visual impairment or being deaf/having a serious hearing impairment.
Mental Health Condition, such as depression or schizophrenia.
Learning Disability/Difficulty (such as Down’s syndrome or dyslexia) or
Cognitive Impairment such as autistic spectrum disorder.
Long Standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy.
Other (please specify)
Your answer
It can help us to ensure effective involvement of everyone if we can identify anything that poses a barrier to your full participation in the workplace. What are the biggest barriers for you in doing what you want to do in this organisation? Please specify:
Your answer
Advertising. Please indicate below how you became aware of this opportunity to allow us to assess the effectiveness of our advertising.
*
Your answer
Thank You for Providing this Information
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