Work Experience *
Please include your last three employers or last 7 years of work history. List your most recent employment first.
Education*
Please indicate your highest grade completed along with the name of the institution attended.
Employer Questions
Voluntary Affirmative Action Questionnaire:
This company may be required by state and federal laws to furnish statistical data and to maintain records of certain population characteristics of those applying for jobs with them. The information you supply will be aggregated and used for statistical purposes only. If you are offered employment with this company, it will not be used as employment criteria. This company is an equal employment opportunity employer supporting diversity in the workplace. Thank you for your cooperation in completing this form.
White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East or North Africa.
Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa.
Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
Asian (Not Hispanic or Latino): 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.
Native American or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.
Native Hawaiian or Pacific Islander (Not Hispanic or Latino):A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.
Two or more races (Not Hispanic or Latino): All persons who identify with more than one of the above five races.
I don’t wish to answer
Male
Female
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Voluntary Veteran Self-Identification Form:
This employer may be a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002,
U.S.C. 4212
(VEVRAA), which requires Government contractors to take affirmative action to employ
and advance in employment: (1) disabled veterans; (2) recently separated veterans;
(3) active duty wartime or campaign badge veterans; and (4) Armed Forces service
medal veterans. These classifications are defined as follows:
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.
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.
An
"active duty wartime or campaign badge veteran" means a 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.
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.
Protected veterans may have additional rights under USERRA—the Uniformed Services
Employment and Reemployment Rights Act. In particular, if you were absent from employment
in order to perform service in the uniformed service, you may be entitled to be
reemployed by your employer in the position you would have obtained with reasonable
certainty if not for the absence due to service. For more information, call the
U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll-free,
at 1-866-4-USA-DOL.
If you believe you belong to
any of the categories of protected veterans
listed above, please indicate by checking the appropriate box below. As a Government
contractor subject to VEVRAA, we request this information in order to measure the
effectiveness of the outreach and positive recruitment efforts we undertake pursuant
to VEVRAA.
I belong to one or more of the classifications of protected veteran listed above
I am not a protected veteran (I served in the military but do not fall into any veteran categories listed above)
I am not a veteran (I did not serve in the military)
I don’t wish to answer
Voluntary Self-Identification of Disability:
Form CC-305
OMB Control Number 1250-0005
Expires 05/31/2023
Why are you being asked to complete this form?
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. Because a
person may become disabled at any time, we ask all of our employees to update their
information at least every five years.
Identifying yourself as an individual with a disability is voluntary, and we hope that you will
choose to do so. Your answer will be maintained confidentially and not be seen by selecting
officials or anyone else involved in making personnel decisions. Completing the form will not
negatively impact you in any way, regardless of whether you have self-identified in the past.
For more information about this form or the equal employment obligations of federal
contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor’s
Office of Federal Contract Compliance Programs (OFCCP) website at
www.dol.gov/ofccp.
How do you know if you have a disability?
You are considered to have a disability 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 an impairment or medical condition.
Disabilities include, but are not limited to:
Autism |
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS |
Blind or low vision |
Cancer |
Cardiovascular or heart disease |
Celiac disease |
Cerebral palsy |
Deaf or hard of hearing |
Depression or anxiety |
Diabetes |
Epilepsy |
Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome |
Intellectual disability |
Missing limbs or partially missing limbs |
Nervous system condition for example, migraine headaches, Parkinson’s disease, or Multiple sclerosis (MS) |
Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression |
Yes, I Have A Disability, Or Have A History/Record Of Having A Disability
No, I Don’t Have A Disability, Or A History/Record Of Having A Disability
I Don't Wish To Answer
PUBLIC BURDEN STATEMENT:
According to the Paperwork Reduction Act of 1995 no persons
are required to respond to a collection of information unless such collection displays
a valid OMB control number. This survey should take about 5 minutes to complete.