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.
Voluntary Self Identification of Protected Veteran Status
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;
and (4) Armed Forces service medal veterans.
These classifications are defined as follows:
A “disabled veteran” is one of the following:
o 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
o 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. Your decision to provide the relevant information is purely voluntary
on your part, and refusal to provide such information will not subject you to any adverse treatment. The information will not be used in a
manner inconsistent with VEVRAA, as amended.
The information 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
Voluntary Self Identification
of Protected Veteran Status
I identify as one or more of the classifications of protected veteran listed above.
I am not a protected veteran.
I don't wish to answer.