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* 1. Salutation

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* 2. First Name

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* 3. Last Name

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* 4. Address

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* 5. City

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* 6. State

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* 7. Zip Code

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* 8. Preferred Phone Number

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* 9. Secondary Phone Number (Optional)

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* 10. Email Address

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* 11. Current or Most Recent Employer

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* 12. Current or Most Recent Job Title

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* 13. How did you first hear about this job opportunity?

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* 14. Can you provide proof, if hired, that you are eligible to work in the United States?

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* 15. Do you now or will you in the future require sponsorship to work in the United States?

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* 16. What is the highest degree you've earned?

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* 17.
VOLUNTARY Self-Identification of Disability
Form CC-305 - OMB Control Number 1250-0005
Expires 5/31/2023
(Note: this question is voluntary. If you choose to answer your response will be kept private and will not be used in any employment or hiring decisions.)

Why are you being asked this information? 
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

Please check one of the boxes below: 

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* 18.
VOLUNTARY Self-Identification of "Protected" Veteran Status
(Note: this question is voluntary. If you choose to answer your response will be kept private and will not be used in any employment or hiring decisions.)

Why are you being asked this information?
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 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.

How do you know if you are a Veteran "Protected" by VEVRAA?
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. The categories are defined on the next page and explained further in an “Am I a Protected Veteran?” infographic provided by 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 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.

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.

Please check one of the boxes below:

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* 19. VOLUNTARY Demographic Information #1:  Gender
(Note: this question is voluntary. If you choose to answer your response will be kept private and will not be used in any employment or hiring decisions.)

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* 20. VOLUNTARY Demographic Information #2:  Are you Hispanic or Latino? 
(Note: this question is voluntary. If you choose to answer your response will be kept private and will not be used in any employment or hiring decisions.)

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* 21. VOLUNTARY Demographic Information #3:  What is your race?
(Note: this question is voluntary. If you choose to answer your response will be kept private and will not be used in any employment or hiring decisions.)

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