SLSQ: Request for Interview Adjustments Form

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Steps for making an application: Please read SLSQ's Workplace Adjustments for Disability policy prior to completing this form (available on the next slide).

1. Please read SLSQ's Workplace Adjustments for Disability policy prior to completing this form (available on the next slide).

2. Please read the SLSQ Reasonable Adjustment Factsheet (available on the next slide).

3. Have an initial discussion with SLSQ Human Resources regarding your request.

4. Complete and submit this form and include any supplementary information and/or documentation to support the application.

Your responses will be treated confidentially and used only to support your experience during the interview process.
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SLSQ Workplace Adjustments for Disability policy
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SLSQ Reasonable Adjustments factsheet
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Request Date* This field is required.
Today's Date
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Month
Day
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Submission Details* This field is required.
Full Name of person completing this form
Email of person completing this form
Role
Location
Supervisor/Manager (if an SLSQ employee)
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Would you like to share anything about a disability, long-term health condition, or neurodivergent experience that may affect how you work?* This field is required.(Sharing this is voluntary and will be handled confidentially.)
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Are there aspects of your work or workplace environment, that create barriers for you?* This field is required.(This could include physical space, communication styles, work hours, technology, etc.)
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Have you accessed any adjustments or support during previous recruitment processes or in previous roles? If yes, what worked well?* This field is required.
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What types of changes or support would help you to thrive during the recruitment process?* This field is required.(Examples: screen reader software, remote interview options.)
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Are there any workplace systems, tools, or practices you would like to recommend?* This field is required.
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How would you like us to handle the information you’ve shared? * This field is required.(e.g., what is your preferred level of confidentiality, who would you like this information to be shared with)?
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Is there anything else you'd like us to understand or consider to support your wellbeing and success through the interview process?* This field is required.
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Signature* This field is required.In signing this request, I declare the above information is true and correct to the best of my knowledge and I acknowledge that my request may be refused on reasonable business grounds. Additionally, I confirm that I have read and understood the Reasonable Adjustment policy.
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People & Culture Approval* This field is required.People & Culture will be notified via email and prompted to resubmit the form with their signature.
People & Culture
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