Our company is an equal opportunity employer working under an Affirmative Action Plan and does not discriminate in hiring or employment on the basis of race, color, religion, sex, national origin, age, disability, or any other basis prohibited by federal, state, or local law. No question on this form is intended to secure information to be used for such discrimination. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria.
Our Affirmative Action Policy is available upon request to all applicants and employees.
The company is required by federal regulations to report information as requested below. Your contribution of this information is completely VOLUNTARY. The information you provide is strictly confidential and will be maintained separate from your personnel file. You may inform us of your desire to benefit under the program at this time and/or any time in the future. Please be advised that this survey is not a part of your official application for employment. It will not be used in any hiring decision. The information will be used and kept confidential in accordance with applicable laws and regulations.
To Vietnam Era Veterans, Other Eligible Veterans, Special Disabled Veterans and Individuals with Disabilities,
Government contractors/subcontractors subject to the Vietnam Era Veterans Readjustment Act of 1974 and the Rehabilitation Act of 1973 are required to take affirmative action to employ and advance in employment Vietnam era and other eligible veterans, qualified special disabled veterans, and qualified disabled individuals. Submission of this information is VOLUNTARY; refusal to provide it will not subject you to any adverse treatment.
Veteran of the Vietnam Era A “Veteran of the Vietnam Era” is a person who served on active duty for more than 180 days, any part of which occurred between August 5, 1964 and May 7, 1975, and was discharged with other than a dishonorable discharge. Veterans meeting the above criteria who served in the Republic of Vietnam between February 28, 1961 and May 7, 1975 are also protected.
Yes
No
Other Eligible Veteran An “Other Eligible Veteran” is defined as a veteran who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized.
Special Disabled Veteran A “Special Disabled Veteran” is a person entitled to compensation under laws administered by the Department of Veteran Affairs for a disability rated at 30% or more, or rated at 10 or 20% in the case of a veteran who has been determined by the Department of Veteran Affairs to have a serious employment handicap, or a person whose discharge or release from active duty was for a service-connected disability.
Disabled Individual A disabled individual is defined as an individual who has a mental or physical impairment that substantially limits one or more major life activities, has a record of such impairment, or who is perceived as having such impairment.
If you are an individual with a disability or a special disabled veteran, we would like to include you under the affirmative action program. It would assist us if you inform us of (1) any special methods, skills and procedures which qualify you for the positions that you might not otherwise be able to do because of your disability so that you will be considered for any positions of that kind, and (2) the accommodations necessary to assist you in performing the job properly and safely, including special equipment, changes in the physical layout of the job, elimination of certain duties relating to the job, provision of personal assistance services, or other accommodations.
