Q1. Voluntary Self-identification Survey – Gender

This company is an Equal Opportunity Employer/Disabled/VETS/Affirmative Action Employer. This survey is meant to help the company fulfill objectives in its affirmative action plans.

Please note that you are not required to complete this survey. Provision of this information is voluntary. The decision not to complete this survey will not affect any opportunity for employment or any benefits with the company. Any information you provide in this survey will be kept confidential and will not be used in any way that may adversely affect your employment with this company.

GENDER (Please select the appropriate box)

 Male
 Female
 Decline to Answer

 Hispanic (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)
 Not Hispanic
 Decline to Answer

Q3. Voluntary Self-identification Survey – Ethnicity/Race (Part 2 of 2)

This company is an Equal Opportunity Employer/Disabled/VETS/Affirmative Action Employer. This survey is meant to help the company fulfill objectives in its affirmative action plans.

Please note that you are not required to complete this survey. Provision of this information is voluntary. The decision not to complete this survey will not affect any opportunity for employment or any benefits with the company. Any information you provide in this survey will be kept confidential and will not be used in any way that may adversely affect your employment with this company.

RACE (If you checked "Not Hispanic" in Part 1 above, please check one or more of the boxes below.)

 White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.)
 Black/African American (A person having origins in any of the Black racial groups of Africa.)
 Native Hawaiian or Other Pacific Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)
 Asian/Indian Subcontinent (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.)

Q4. Voluntary Self-Identification of Disability
Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2020

Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I 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:

* Blindness

* Autism

* Bipolar Disorder

* Post-traumatic stress disorder (PTSD)

* Deafness

* Cerebral palsy

* Major depression

* Obsessive compulsive disorder

* Cancer

* HIV/AIDS

* Multiple sclerosis (MS)

* Impairments requiring the use of a wheelchair

* Diabetes

* Schizophrenia

* Missing limbs or partially missing limbs

* Intellectual disability (previously called mental retardation)

* Epilepsy

* Muscular dystrophy

Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
_________________________
Section 503 of the Rehabilitation Act of 1973, as amended. 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.

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.

Please check one of the boxes below:
 

 YES, I HAVE A DISABILITY (or previously had a disability)
 NO, I DON'T HAVE A DISABILITY
 I DON'T WISH TO ANSWER