Application form - Islington Council
Application form - Islington Council
Application form - Islington Council
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EOP’s DIVERSITY MONITORING<br />
We monitor a range of in<strong>form</strong>ation about our customers to help us to provide a suitable service and<br />
ensure people are not discriminated against because of their race, language, disability, faith or sexual<br />
orientation. Please provide us with the following in<strong>form</strong>ation to help us do this.<br />
What is the first language used by the<br />
applicant?<br />
What is the ethnicity of the applicant? (use code<br />
from list at back of this <strong>form</strong>)<br />
Does the applicant belong to one or more of these groups? Tick all boxes that apply.<br />
Gypsy or Traveller<br />
Refugee<br />
Migrant Worker<br />
Does the applicant consider himself/herself as<br />
having a disability?<br />
None of these<br />
Yes<br />
No<br />
What type of disability does the applicant have? Tick all boxes that apply.<br />
Blind<br />
Partially sighted<br />
Profoundly deaf<br />
Speech impairment<br />
Limited mobility<br />
Wheelchair use (full)<br />
Mental health<br />
Partial hearing<br />
Learning difficulties<br />
Physical co-ordination difficulties<br />
Wheelchair use (partial)<br />
Other (please note below)<br />
Circle Anglia has a policy of equal access regardless of language needs or disability. Do you require<br />
any particular communication arrangements?<br />
Written translation into first<br />
Spoken interpretation into first language<br />
language<br />
Large print English<br />
Audio CD<br />
Braille<br />
Large print first language<br />
Audio cassette<br />
Pictorial<br />
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