18 -25 26-64 65 & over Please select the option which best describes your sexual orientation Lesbian Heterosexual Gay I do not wish to disclose Bisexual Please indicate your religion or belief Atheism Jainism Any other Please specify Buddhism Sikhism Christianity Judaism I do not wish to disclose Islam Hinduism Equality Act 2010 The Equality Act 2010 protects disabled people including those with long term health conditions, learning disabilities and so called hidden disabilities such as dyslexia. If you tell us you have a disability we can make reasonable adjustment to ensure than the selection process including interview is fair and equitable. Yes Do you consider yourself to have a disability? No I do not wish to disclose Please state the type of impairment which applies to you. People may experience more than one type of impairment, in which case you may indicate more than one. If none of the categories apply please select ‘Other’. Physical Impairment Learning Disability/Difficulty Sensory Impairment Long standing illness Mental Health Problem Other Rehabilitation of Offenders Act 1974 Croydon Clinical Commissioning Group undertakes not to discriminate unfairly against applicants on the basis of a criminal conviction. Are you currently bound over, or do you have any unspent convictions issued by a Court Court Martial in the UK or any other country? Yes No
18 -25 26-64 65 & over Please select the option which best describes your sexual orientation Lesbian Gay Bisexual Heterosexual I do not wish to disclose Please indicate your religion or belief Atheism Buddhism Christianity Islam Jainism Sikhism Judaism Hinduism Any other Please specify I do not wish to disclose Equality Act 2010 Do you consider yourself to have a disability? Yes No I do not wish to disclose Please state the type of impairment which applies to you. People may experience more than one type of impairment, in which case you may indicate more than one. If none of the categories apply please select ‘Other’. Physical Impairment Sensory Impairment Mental Health Problem Learning Disability/Difficulty Long standing illness Other The Equality Act 2010 protects disabled people including those with long term health conditions, learning disabilities and so called hidden disabilities such as dyslexia. If you tell us you have a disability we can make reasonable adjustment to ensure than the selection process including interview is fair and equitable. Rehabilitation of Offenders Act 1974 Croydon Clinical Commissioning Group undertakes not to discriminate unfairly against applicants on the basis of a criminal conviction. Are you currently bound over, or do you have any unspent convictions issued by a Court Court Martial in the UK or any other country? Yes No
MONITORING%20INFORMATION%20CCG.docx