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Personal Information

 
 
 
 
 
 
   

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Additional Information


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Voluntary Equal Opportunity Questionnaire

This company is dedicated to a policy of affirmative action and equal opportunity in employment without regard to race, religion, gender, national origin, age, veteran or disabled status, or any other protected class. Reasonable accommodation will be made as appropriate to enable any employee or applicant for employment to safely and properly perform the job applied for as requested and as appropriate.

The following information is necessary for this company to evaluate its hiring practices and to track its progress and effectiveness in complying with its Affirmative Action Plan and equal employment policies. The information is voluntary and will be kept confidential insofar as possible. Information provided will not be negatively considered in any part of the selection process.
 

 


Voluntary Self-Identification of Disability

Voluntary Self-Identification of Disability

Form CC-305

OMB Control Number 1250-0005

Expires 1/31/2020

Voluntary Self-Identification of Disability

 

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
  • Epilepsy         
  • Schizophrenia
  • Muscular dystrophy   
  • Missing limbs or partially missing limbs         
  • Intellectual disability (previously called mental retardation)  

Please check one of the boxes below:

 

Voluntary Self-Identification of Disability

Voluntary Self-Identification of Disability

Form CC-305

OMB Control Number 1250-0005

Expires 1/31/2020


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.

______________________________________________

[1] 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.


Veteran Status Solicitation

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), 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
  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.

   

Application Disclosure

All qualified applicants will receive consideration for employment without regard to race, religion, gender, national origin, age, veteran or disabled status, or any other protected class.  No information will be used for the purpose of discrimination.

I understand that, if hired, my status is that of an employee at will, meaning that I have no contractual right, express or implied, to remain in this company's employ. In consideration of my employment, I specifically agree that my employment or the terms and conditions thereof including compensation and benefits can be changed or terminated with or without cause and with or without notice at any time at the option of this company. I further understand that, if hired, my employment is for no definite period and either this company or I may terminate our relationship at will at any time. My expression of interest in IAI does not constitute an employment contract. It is further agreed that this "at will" employment relationship may not be changed by any written document or by conduct, unless such change is specifically agreed and acknowledged in writing by an authorized executive of this organization.

I voluntarily grant this company the right to investigate and verify the information and statements I have provided on my resume and agree to hold all persons harmless with respect to any information they may give, receive or verify.  I understand that the company may obtain consumer reports or investigative reports for employment purposes that relate to my credit, criminal, driving, employment, or education history.  I further understand that I have the right to request, in writing, the nature and scope of any investigative consumer report and a Summary of Consumer Rights as prescribed by the Fair Credit Reporting Act.

I agree that, if hired, I will observe all policies and strict confidentiality concerning all affairs of this company and its members.

By applying, I affirm that I have read and agree to all of the disclosures and conditions included herein.

 


 
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