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Disability Confident Employer Scheme
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* Indicates required question
1. Name
Your answer
2. Email
Your answer
3. Do you have a Disability or an Impairment?
*
Cognitive or learning disability
Hearing impairment/deaf
I do not have a disability or impairment
Invisible disabilities
Mental health condition
Neurodiverse
Other (Please state below)
Other long term/chronic illness
Physical disabilities
Prefer not to say
Visual impairment
Required
4.1. If you chose "Other" please specify.
Your answer
5. Do you require assistance to attend an interview if selected? E.g. a support worker or interpreter. Please state below.
Your answer
6. Do you require the application form to be in large print or audio?
Your answer
7. If applicable, please let us know of any adjustment requirements
*
Your answer
8. Any other information
Your answer
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