ࡱ> 685'`  bjbj{P{P 2::y$\\\\<<<PTTTT `$PI%%%$5h\<%\\ |||\<|||@<| l=T"|0I|>.|<|L%"G|_s%%%l%%%IPPP TPPPTPPP\\\\\\ Monitoring Form  Reference Number  FAIR EMPLOMENT ACT 1989 (Northern Ireland) STATEMENT OF COMMUNITY BACKGROUND Please indicate your community background by ticking the appropriate box below:  I am a member of the Protestant community  I am a member of the Roman Catholic community I am a member of neither the Protestant nor the Roman Catholic Community GENDER OF APPLICANT  Male Female  DISABILITY Under the Disability Discrimination Act 1995 a person is considered to have a disability if he/she has or has had a physical or mental impairment which has a substantial and long term adverse affect on his/ her ability to carry out normal day to day activities. Do you consider that you meet this definition of disability? Yes No If Yes please state the nature of effects of you disability: ______________________________________________________________________________________________________________________________________________________________________________  ORIGIN OF APPLICATION Where did you see this position advertised?  Newspaper (please specify)  Internet (please specify website)  Other (please specify) Thank you for your co-operation, the information which you give on this form will be treated in the strictest confidence, and will not be used for any purpose other than monitoring the Companys policy on equality of opportunity.   WC/DC/08 ()*x& ' s  3 4 A O Q R _ u w x hrh7hVhEEjh~ Ujh~ U h~ CJh~ h~ 5CJ\"jh~ CJUmHnHsH u"jh#CJUmHnHsH u h~ CJh~ 5:CJ 0%(*UVxy% & g q r s #$d?%d?&d?'d?N?O?P?Q?#$d?%d?&d?'d?N?O?P?Q?y  < =   3 5 Q #$d?%d?&d?'d?N?O?P?Q?Q T w y y z { | } ~  #$d?%d?&d?'d?N?O?P?Q? 0&P 1N. A!n"n#$% Dd  0  # A2M42 ^+?)D`!!42 ^+?v`xcdd``> "@ X>( S &aLLJ% eA3Y`]FA+`V ZZ<QMb Hq]y%C9.ؕ.JHAf3UK0,?6,`03" /3X%:wDd  0  # A2M42 ^+?)`!!42 ^+?v`xcdd``> "@ X>( S &aLLJ% eA3Y`]FA+`V ZZ<QMb Hq]y%C9.ؕ.JHAf3UK0,?6,`03" /3X%:w@@@ NormalCJ_HaJmH sH tH 8@8 Heading 1$@&CJ@ Heading 2L$$d?%d?&d?'d?@&N?O?P?Q? 5CJ\DAD Default Paragraph FontViV  Table Normal :V 44 la (k(No List 2B@2 Body TextCJzP@z Body Text 2F$d?%d?&d?'d?N?O?P?Q?CJHH {3 Balloon TextCJOJQJ^JaJ##&%(*UVxy%&gqrs<=35QTwyyz{|}~0@000@0@0@0@0@0@0@000000000000000000000000000000000000000000000000`00000000 00000 \  Q   8@`(  T  C  N  3  H  #  H  #   (   (   (    (   (   (   (   (  V  # "` B S  ?(&3QwC<tL&gtL&+tt t t tt }tL&tCL& trt rtrtbB bB CCSSB*urn:schemas-microsoft-com:office:smarttagscountry-region9*urn:schemas-microsoft-com:office:smarttagsplace ptxyy3*yy~ s.cE&  B :NO5%f&2ru@xur #''0e1{3$D3E39~F:<4c<w<>R>}>?L6?$ ANCEEeyJ{OOx}Q`S0KSBqS6UW"YW[\Z]R_{a c>&cy9cYdTBiKigjk\4mKn*rbcs.t Au( vj#w/[z}X9N $Fgpj M7Hj[VU=ce>Yby@ W.tQ871N]Fa"SF23iXn.V}588t{h^(XB =1^^p6: 62` `"_j';r2RM{@xp@UnknownGz Times New Roman5Symbol3& : Arial5& zaTahoma"hj   n9'24dww2HX)?r2Monitoring FormgmcneillITOh+'0  < H T `lt|Monitoring Form gmcneill Normal.dotIT145Microsoft Office Word@vWI@\j@8@.c=՜.+,0 hp  Galen Holdings plc w' Monitoring Form Title  !"#$&'()*+,./012347Root Entry Fl=9Data 1TableWordDocument2SummaryInformation(%DocumentSummaryInformation8-CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q