Fillable VOLUNTARY APPLICANT SELF-IDENTIFICATION FORM SURVEY

Fill Online, Printable, Fillable, Blank VOLUNTARY APPLICANT SELF-IDENTIFICATION FORM SURVEY Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

VOLUNTARY APPLICANT SELF-IDENTIFICATION FORM SURVEY

On average this form takes 4 minutes to complete

The VOLUNTARY APPLICANT SELF-IDENTIFICATION FORM SURVEY form is 1 page long and contains:

  • 0 signatures
  • 0 check-boxes
  • 16 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Page 1 of 2
Voluntary Applicant Self-Identification Page 1 of 2 Revised July 2016
VOLUNTARY APPLICANT SELF-IDENTIFICATION FORM SURVEY
For statistical reporting we ask that you voluntarily provide the information below.
This voluntary survey assists us in complying with government recordkeeping, reporting, and other legal requirements.
Your completion of this survey is optional. If you choose to disclose the requested information, please note that this form
will be kept in a confidential file and is not a part of your personnel file.
YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT
ANY EMPLOYMENT DECISION.
Name: Date:
Ch
eck one: Male Female I do not wish to self-identify.
Ch
eck one of the following (see next page for definitions):
Hispanic or Latino OR
Two or More Races (not Hispanic or Latino)
Asian (not Hispanic or Latino)
White (not Hispanic or Latino)
Native Hawaiian or other Pacific Islander
(not Hispanic or Latino)
American Indian or Alaskan Native
(not Hispanic or Latino)
I do not wish to self-identify.
Protected Veteran Status: We are 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. (The terms are defined on the back of this form).
If you believe you belong to any of the categories of protected veterans listed in the definitions attached to and included
with this form, please indicate by checking the appropriate box below. As a Government contractor, we request this
information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant
to VEVRAA.
I identify as one or more of the classifications of protected veterans listed in the attached definitions.
I identify as a veteran, just not a protected veteran.
I am not a veteran.
I do not wish to self-identify.
It is the practice of Compass Group to provide a work environment that is free from unlawful discrimination and
harassment based on sex, sexual orientation, gender identity, race, religion, color, disability, age, pregnancy, child birth or
any related condition, national origin, veteran status, genetic information, protected concerted activity, or any other
classification protected by law. Please note that this form will be kept confidential and used only in accordance with
applicable laws and regulations. When reported to the government in a statistical format, the data will not identify any
specific individual. Providing this information is strictly voluntary. Failure to provide it will not subject you to any adverse
employment decision or action. Your cooperation is appreciated.
Page 2 of 2!
Voluntary Applicant Self-Identification Page 2 of 2 Revised July 2016
!
AFFIRMATIVE ACTION RACE/ETHNICITY DEFINITIONS
American Indian or Alaskan Native:
A person with origins in any of the original peoples of North America
and South America (including Central America) and who maintains cultural identification through tribal affiliation
or community attachment.
Asian: A person with origins in any of the original peoples of the Far East, Southeast Asia, or the Indian
subcontinent. This area includes, for example, Cambodia, China, Japan, Korea, the Philippine Islands, Malaysia,
Pakistan, Thailand, and Vietnam.
Black/African-American:
A person, not of Hispanic origin, with origins in any of the black racial groups of Africa.
Native Hawaiian or other Pacific Islander: A person having origins in any of the peoples of Hawaii,
Guam, Samoa, or other Pacific Islands.
White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Two or More Races (Not Hispanic or Latino):
A person who identifies with more than one of the above
five races.
Hispanic or Latino: A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish
culture or origin regardless of race.
AFFIRMATIVE ACTION PROTECTED VETERAN STATUS DEFINITIONS
Disabled Veteran: 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.
Recently Separated Veteran: 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.
Active Duty Wartime or Campaign Badge Veteran: 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.
Armed Forces Service Medal Veteran: Any 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.
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.
Voluntary Self-Identification of Disability
Form CC-305 OMB Control Number 1250-0005
Page 1 of 1 Expires 05/31/2023
Name: Date:
Employee ID:
(if applicable)
Why are you being asked to complete this form?
We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people
with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals
with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability.
Because a person may become disabled at any time, we ask all of our employees to update their information at least
every five years.
Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer
will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel
decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in
the past. For more information about this form or the equal employment obligations of federal contractors under Section
503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs
(OFCCP) website at www.dol.gov/ofccp
.
How do you know if you 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:
• Autism
•
Autoimmune disorder, for example,
lupus, fibromyalgia, rheumatoid
arthritis, or HIV/AIDS
•
Blind or low vision
•
Cancer
•
Cardiovascular or heart disease
•
Celiac disease
•
Cerebral palsy
•
Deaf or hard of hearing
•
Depression or anxiety
•
Diabetes
•
Epilepsy
•
Gastrointestinal disorders, for
example, Crohn's Disease, or
irritable bowel syndrome
•
Intellectual disability
•
Missing limbs or partially missing
limbs
•
Nervous system condition for
example, migraine headaches,
Parkinson’s disease, or Multiple
sclerosis (MS)
• Psychiatric condition, for example,
bipolar disorder, schizophrenia,
PTSD, or major depression
Please check one of the boxes below:
☐
Yes, I Have A Disability, Or Have A History/Record Of Having A Disability
☐
No, I Don’t Have A Disability, Or A History/Record Of Having A Disability
☐
I Don’t Wish To Answer
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.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

VOLUNTARY APPLICANT SELF-IDENTIFICATION FORM SURVEY

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 25 February 2022

Message

View Audit Log
Print With Audit Log
Duplicate Document