As part of our responsibilities as an employer with an Affirmative Action program, we are required to make periodic reports to the government. We would like to ask your help. Would you be willing to complete an Applicant Data Record? This document asks various questions to help us comply with government record keeping, reporting and other legal requirements. It is totally voluntary. Inclusion or exclusion of any data will not affect any employment decision.
Affirmative Action Survey
Government agencies require periodic reports on the sex, ethnicity, disability and veteran status of applicants. This data is for analysis and affirmative action only. Submission of information is voluntary.
SPECIAL EMPLOYMENT NOTICE TO DISABLED VETERANS, VIETNAM ERA VETERANS, AND INDIVIDUALS WITH PHYSICAL OR MENTAL DISABILITY:
Government contractors are subject to 38 USC 2012 of the Vietnam Era Veterans Adjustment Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative actions to employ and advance in employment qualified handicapped individuals.
If you are a disabled veteran, or have a physical or mental disability, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job to the best of your ability in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect your consideration for employment.
If you believe yourself to have a mental or physical disability that would substantially restrict or limit your ability to perform the job or work you have applied for, or restrict or limit you in advancing in your employment, please explain:
Federal Law defines the term "qualified handicapped individual" as: "a person with a handicap who with reasonable accommodation is capable of performing the essential functions of the particular job in question within normal operations of the employer’s business in terms of physical requirements, education, skill and experience."
Please indicate your agreement with the information you have provided by completing the following:
