| *First Name |
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| *Last Name |
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| *Email |
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| *Mobile Number |
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| *CV |
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| *City |
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| *Country |
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| *Region |
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| *Area(s) of Interest |
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| *LinkedIn Profile URL |
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Community Background:
Regardless of whether they actually practice a particular religion, most people in Northern Ireland are perceived to be members of either the Protestant or Roman Catholic communities. |
| *Please indicate the community to which you belong by ticking the appropriate button below |
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| If you do not answer the above question, or if you tick the “not a member of either” box, we are encouraged to use the residuary method of making a determination, which means that we can make a determination as to your community background on the basis of the personal information supplied by you in your application form/personnel file. |
| Sex: |
| *Please indicate your sex by ticking the appropriate box below: |
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| Note: If you answer these questions about community background and sex you are obliged to do so truthfully, as it is a criminal offence under the Fair Employment (Monitoring) Regulations (NI) 1999 to knowingly give false answers to these questions. |
| Age: |
| *Please state your date of birth: |
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| Racial Group: |
| *Please state your country of birth: |
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| *Please state your nationality: |
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| *Please indicate which of the following applies to you: |
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| Mixed ethnic group (please state which): |
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| Any other ethnic group (please state which): |
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| Disability |
Under the Disability Discrimination Act 1995 you are deemed to be a disabled person if you have cancer, multiple sclerosis or HIV infection.
Also, you are deemed to be a disabled person if you have a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities. |
| *Do you consider that you are a disabled person? |
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| If you answered “yes”, please indicate the nature of your impairment by ticking the appropriate box or boxes below: |
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| If you answered "other" above, please indicate the other disability. |
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| Sexual Orientation: |
*Please indicate your sexual orientation by ticking the appropriate box below:
My Sexual Orientation is: |
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Marital Status / Civil Partnership Status:
Please indicate whether you are married or in a civil partnership by ticking the appropriate box below: |
| *Are you married or in a civil partnership? |
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| Dependants / Caring Responsibilities: |
| *Do you have dependants, or caring responsibilities for family members or other persons? |
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| If you answered “yes”, who are your dependants or the people your look after? (Please tick the appropriate box or boxes): |
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| If "Other", please specify: |
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