UID Number: UID
UID Number: «UID»
Please tick/complete the appropriate boxes below. Please note that incomplete monitoring information may mean your application is not considered.
Equality Monitoring Form
PSNI in compliance with its responsibilities under Section 75 of the Northern Ireland Act 1988, seeks the following information to monitor the impact that our recruitment process has on the nine groups of people described under the above Act.
National Insurance or Personal Public Service Number
DOMESTIC STATUSSingle / Married / Widowed / Separated / Divorced / Civil Partner / Co-Habitee
GENDER
Male / Female
DATE OF BIRTH / ______/______/______
SEXUAL ORIENTATION
Under the Employment Equality (Sexual Orientation) Regulations (NI) 2003 it is unlawful for employers to discriminate against a person on the grounds of sexual orientation. In order to monitor potential employees, you are requested to complete the section below. Are You?
Heterosexual / Bi – Sexual / Gay/Lesbian / Prefer not to say
POLITICAL OPINION
Unionist / Nationalist / Other / None / Prefer not to say
DEPENDANTS
Do you have personal responsibility for the care of:
A Child / A Person with a Disability / An Elderly Person / None
ETHNIC ORIGIN
White / Chinese / Indian / Pakistani / Bangladeshi / Irish Traveller
Black African / Black Caribbean / Black Other / Mixed Ethnic Group / Other
(Please Specify)
COMMUNITY BACKGROUND
You are requested to indicate below your community background or the community background to which you would be perceived to belong. Failure to complete Part 1 and return the Equality & Monitoring Form may mean that your application will not be accepted. Giving false information or withholding relevant information could result in dismissal. You are also requested to provide schooling information for residuary monitoring purposes if required.
I am a member of the Protestant community
I am a member of the Roman Catholic community
Other (please specify)
Did you attend a primary, preparatory or secondary school in Northern Ireland? / Yes / No
If yes, please list the names and full addresses of all the schools in order of attendance
Name of School / Type of school (Primary / Secondary) / Full Postal Address
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.
Do you consider yourself to have a disability?Yes No
Does your disability result from one or more of the impairments or conditions listed below? Please indicate which:
Hearing impairment / Mobility impairment / Severe disfigurement
Visual impairment / Physical co-ordination Difficulties / Learning difficulties
Writing Difficulties / Reading Difficulties / Mental illness/mental health difficulties
Speech impediment / Reduced physical capacity
GUIDANCE NOTES ON COMPLETING THE DISABILITY SECTION.
Disability
What do the disabilities and conditions listed mean?
The guidance that follows contains examples of conditions that might give rise to particular categories of disability:
Hearing impairment: For example being deaf or hard of hearing. If you wear a hearing aid that brings your level on a par with the average, you are still considered to have a disability
Visual impairment: For example, being registered blind or partially sighted. If your sight is corrected by the use of spectacles or contact lenses this is not considered a disability
Speech impairment: For example, being unable to speak, or having difficulty in speaking.
Mobility impairment: For example, being unable to walk only limited distances, having difficulty sitting, standing, bending or reaching; having difficulty climbing stairs, using a normal means of transport; needing to use a walking stick, crutches or wheelchair.
Physical co-ordination difficulties: This relates to balance and effective interaction of body movement, including hand and eye co-ordination, and might include, for example, problems of manual dexterity and of muscular control e.g. incontinence, epilepsy, Parkinson’s disease.
Reduced physical capacity: This includes debilitating pain and lack of strength, breath energy or stamina, which may arise, for example, from cardiovascular conditions, asthma, diabetes. It may also result from progressive conditions e.g. muscular dystrophy, cancer, multiple sclerosis, HIV /AIDS. (The Disability Discrimination Act 1995 provides for people with these progressive conditions to be regarded as having a disability as soon as impairment arising from the condition has some effect on the ability to carry out normal day-to-day activities. The effect does not have to be continuous or substantial.)
Severe disfigurement: For example scars, birthmarks, limb or postural deformation or diseases of the skin. A tattoo is not considered as a severe disfigurement.
Learning difficulties: Includes the mental ability to perceive physical danger
Mental illness: For example, having schizophrenia, clinical depression, severe phobias
The information you provide will be treated in the strictest confidence and kept separately from the application information. It will not be seen by assessors and will not be used in deciding your progress through the assessment process or your suitability to enter the pool of qualified candidates.