Applicant Voluntary Self-Identification

Select
Caret IconCaret symbol

Survey of Gender and Race/Ethnic Group

Our organization is an equal opportunity employer and government contractor. It has been and shall continue to be both the official policy and the commitment of the Company, including all its divisions to further equal employment opportunities in hiring or employment. Our organization is committed to the employment and advancement of minorities, females, individuals with disabilities and veterans. No question on this form is intended to secure information to be used for such discrimination.


Completion of this form is voluntary and in no way affects the decision regarding your employment opportunity. Our organization is required by federal regulations to report information as requested below. The information provided will be held in the strictest confidence, will be maintained in a separate file, and will not be used in a manner inconsistent with the Acts. You may inform us of your status related to the following data or your change in status at at this time and any time in the future.

Select
Caret IconCaret symbol


American Indian or Alaskan Native: A person having origins in any of the original peoples of North and South American (including Central America), and who maintain tribal affiliation or community attachment.


Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.


Black/African American: A person having origins in any of the black racial groups of Africa.


Hispanic/Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.


Native Hawaiian or Other Pacific Islander: A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.


White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.


Two or More Races: All person who identify with more than one of the following: American Indian or Alaskan Native, Asian, Black/African American, Native Hawaiian or Other Pacific Islander, White.


Select or enter value
Caret IconCaret symbol

Voluntary Self-Identification of "Protected" Veteran Status


WHY ARE YOU BEING ASKED TO COMPLETE THIS FORM?

This employer is a Government Contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA). VEVRAA requires Government contractors to take affirmative action to employ and advance in employment protected veterans. To help us measure the effectiveness of our outreach and recruitment efforts of veterans, we are asking you to tell us if you are a veteran covered by VEVRAA. Completing this form is completely voluntary, but we hope you fill it out. Any answer you give will be kept in private and will not be used against you in any way. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.


WHAT CATEGORIES OF VETERANS ARE "PROTECTED" BY VEVRAA?

"Protected" veterans include the following categories: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These categories are defined below.


1. A "disabled veteran" is one of the following:

  • a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
  • A person who was discharged or released from active duty because of a service-connected disability.       


2. A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.


3. An "active duty wartime or campaign badge veteran" means any veteran who served on active duty in the U.S. military, ground, naval, or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.


4. An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Contrary to the name, VEVRAA does not just cover Vietnam Era veterans. It covers several categories of veterans from World War II, the Korean conflict, the Vietnam era, and the Persian Gulf War which is defined as occurring from August 2, 1990 to the present.


If you believe you belong to any of the categories of protected veterans please indicate by checking the appropriate box below.

Select or enter value
Caret IconCaret symbol

Voluntary Self-Identification of Disability

 

We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability.


Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. If you do choose to do so, please access the Government Form CC-305. Complete the form and include it as an attachment to this Voluntary Self-Identification questionnaire. If you choose to complete the form and submit it, please also select the appropriate dropdown below.

                        

Select or enter value
Caret IconCaret symbol
Drag and drop files here or
Privacy Notice|Report Abuse