Voluntary Disclosure Form

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It is the policy of this company to provide equal employment opportunity to all employees and applicants for employment without regard to race, color, religion, sex, national origin, handicap or veterans status; or status within any other protected group. Various agencies of the United States government require employers to collect information about applicants. Information requested on this sheet is for purposes of compliance with these record-keeping requirements and to determine recruiting and employment patterns. Such information will in no way affect the decision regarding your application for employment. This sheet will be kept confidential and maintained separately from your application form. Completion of this sheet is voluntary and is not a requirement for employment.

Regulations issued by the U.S. Department of Labor with respect to handicapped individuals, disabled veterans, and Vietnam era veterans require that federal contractors provide a self-identification opportunity to applicants for employment. Such self-identification and any information provided by the applicant is submitted (a) on a voluntary basis, (b) on a confidential basis, (c) for use only in accordance with regulations, and (d) without subjecting the individual to adverse treatment. If you wish to be identified, please provide any information you wish to submit. If an applicant or employee so identifies him self or her self, the company shall seek the advice of the applicant or employee regarding proper placement and appropriate accommodation.

A person who has a physical or mental impairment that would cause him/her to have difficulty in securing, retaining, or advancing in a job or a person who has a history of this type of impairment or anyone who is regarded as having such an impairment.
A person who: (1) served on active duty for a period of more than 180 days, any part of which occurred between August 5, 1964 and May 7, 1975, and was discharged or released with other than a dishonorable discharge and/or (2) was released from active duty for a service connected disability if any part of such duty was performed during the same period.
A person who: (1) a veteran entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans� Affairs for a disability a) rated at 30 percent or more or b) rated at 10 or 20 percent in the case of a veteran who has been determined under Section 3106 of Title 38, USC to have a serious employment handicap or (2) a person who was discharged or released from active duty because of a service connected disability.
A person who served in the military, ground, naval or air service of the United States on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized. To identify the campaigns or expeditions that meet this criterion, contact the Office of Personnel Management and ask for the OPM VETS guide, Appendix A.