US Equal Opportunity Employment Notice (completion is voluntary)
Persons seeking employment in public are presumed to be regardless of race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation. To help us comply with federal and state Equal Employment Opportunity/affirmative action record keeping, reporting and other legal requirements, you are being offered the opportunity to provide the following information.
The completion of the form is completely voluntary. Whatever your decision, will not be considered in the hiring process or thereafter. Any information you provide will be recorded and maintained in a confidential file.
Race and Ethnicity Definitions
If you believe you belong to any of the categories of protected veterans listed below, please indicate by selecting the appropriate one. As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRA), we request this information to measure the effectiveness of outreach and positive recruitment efforts carried out in accordance with VEVRAA. The classification of protected categories is as follows:
A “disabled veteran” is one of the following: a veteran of the U.S. military, land, navy or air service who is entitled to compensation (or who would be entitled to compensation for the receipt of military retired pay) under laws administered by Veterans Affairs. Secretary to or a person who has been discharged or released from active duty by reason of a service-connected disability.
“Recently Discontinued Veteran” means any veteran during a three-year period beginning with the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval or air service.
An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. Army, ground, naval, or air service during the war, or in a campaign or campaign for which a campaign badge is recognized by laws. Administered by the Department of Defense.
An “Armed Forces Service Medal Veteran” means a veteran who, while serving on active duty in the U.S. Army, ground, naval, or air service, participated in a United States military operation for which an Armed Forces Service Medal is an executive order. was granted as per 12985.
OMB control number 1250-0005
Why are you being asked to fill out this form?
We are a federal contractor or subcontractor required by law to provide equal employment opportunities to people with disabilities. We also need to measure our progress towards having at least 7% of our workforce be persons with disabilities. To do this, we must ask applicants and employees if they have or have ever had a disability. Since a person can become disabled at any time, we ask all of our employees to update their information at least every five years.
Identifying yourself as a person with a disability is voluntary, and we hope that you will choose to do so. Your reply will be kept confidential and will not be viewed by select officials or any other person involved in personnel decision making. Filling out the form will not negatively impact you, even if you have identified yourself in the past. For more information on this form or the similar employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of the Federal Contract Compliance Program (OFCCP) website at www.dol.gov/ofccp.
How do you know if you are disabled?
You are considered disabled if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such impairment or medical condition.
Disabilities include, but are not limited to:
- Autoimmune disorders, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS
- blind or low vision
- heart or heart disease
- celiac disease
- cerebral palsy
- Deaf or hard of hearing
- depression or anxiety
- Gastrointestinal disorders, for example, Crohn’s disease, or irritable bowel syndrome
- intellectual disability
- missing limbs or partially missing limbs
- Nervous system conditions, for example, migraine headaches, Parkinson’s disease, or multiple sclerosis (MS)
- Psychiatric conditions, for example, bipolar disorder, schizophrenia, PTSD, or major depression
1Section 503 of the Rehabilitation Act of 1973, as amended. For more information on this form or similar employment obligations for federal contractors, visit the US Department of Labor Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.
Public Burden Statement: The Paperwork Reduction Act of 1995 does not require any person to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take approximately 5 minutes to complete.