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Personal Information

 
 
 
 
 

How did you hear about us?

If you selected "Employee Referral" in the source box above please list our employees name in the "Referred By" box.

 


Additional Information

Do you have any relatives currently employed at FedData?  Yes/No

 

If yes, please provide name of relative.

 

If Yes, please know that FedData HR will be reaching out to you for additional information.

 

What is your current Clearance Level?

Are you subject to the terms of an employment agreement, including any non solicitation or non compete restrictions? 

If answer is YES, please provide details.

If answer is NO, please write N/A.

Are you subject to the terms of any organizational or personal conflict of interest agreement?

If answer is YES, please provide details.

If answer is NO, please write N/A.

Are you subject to any restrictions stemming from prior Government service? 

If answer is YES, please provide details.

If answer is NO, please write N/A.


Employment History:

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Self-Identification Data Record

The purpose of this Data Record is to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The information on this survey is voluntary and will be kept confidential. Disclosure or refusal to provide the information will not subject you to any adverse treatment.

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.i 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• Cerebral palsy• Multiple sclerosis (MS)
• Deafness• HIV/AIDS• Missing limbs or partially missing limbs
• Cancer• Schizophrenia• Post-traumatic stress disorder (PTSD)
• Diabetes• Major depression• Obsessive compulsive disorder
• Epilepsy• Bipolar disorder• Impairments requiring the use of a wheelchair
• Autism• Muscular dystrophy• Intellectual disability (previously called mental retardation)
 

Please Select one of the options below :

   
 
Format: MM/DD/YYYY

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.
i 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 US. 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.

Invitation To Voluntarily Self-Identify 

The purpose of this request is to comply with certain federal Equal Opportunity and Affirmative Action obligations, including those promoted by the Vietnam Era Veterans’ Readjustment Assistance Act (VEVRAA) of 1974. Your participation is voluntary. Your failure or refusal to provide this information will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended. 

VEVRAA Survey 

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. 

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), requires certain 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; and (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. 

 

Invitation To Voluntarily Self-Identify 

The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed. 


 
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