Fillable Voluntary Info Form 2018

Fill Online, Printable, Fillable, Blank Voluntary Info Form 2018 Form

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

Voluntary Info Form 2018

On average this form takes 6 minutes to complete

The Voluntary Info Form 2018 form is 3 pages long and contains:

  • 0 signatures
  • 10 check-boxes
  • 19 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Alvin Community College

BROWSE ALVIN COMMUNITY COLLEGE 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
 
Voluntary Self-Identification
Alvin Community College is subject to certain governmental recordkeeping and reporting
requirements for the administration of civil rights laws and regulations. In order to comply
with these laws, we invite employees to voluntarily self-identify their race and ethnicity.
Submission of this information is voluntary and refusal to provide it will not subject you to any
adverse treatment. The information will be kept confidential and will only be used in
accordance with the provisions of applicable laws, executive orders and regulations, including
those that require the information to be summarized and reported to the federal government
for civil rights enforcement. When reported, data will not identify any specific individual.
Completion of information below is voluntary.
Name:
Employee ID#
What is your Gender?
Female
Male
I prefer not to answer.
Are you Hispanic or Latino?
Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish
culture or origin regardless of race.
Yes
No
I prefer not to answer.
Optional Race Category: (Check all that apply)
If you have identified yourself as Hispanic or Latino, you are not required to select an additional category.
American Indian or Alaska Native - A person having origins in any of the original peoples of
North and South America (including Central America), and who maintains tribal affiliation or
community attachment.
Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or
the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia,
Pakistan, the Philippine Islands, Thailand, and Vietnam.
Black or African American - A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander - A person having origins in any of the original 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.
I prefer not to answer.
Please return this form to: Office of Human Resources – Email: HR@alvincollege.edu,
Office: C132, Fax: 281-756-3683, or Mail: 3110 Mustang Rd. Alvin, TX 77511
Voluntary Self-Identification of Veterans
As 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.
As a Government contractor subject to VEVRAA, we are required to submit a report to the United States Department of Labor each
year identifying the number of our employees belonging to each specified “protected veteran” category. If you believe you belong to
any of the categories of protected veterans listed above, please indicate by checking the appropriate box below.
I BELONG TO THE FOLLOWING CLASSIFICATIONS OF PROTECTED VETERANS (CHOOSE ALL THAT APPLY):
DISABLED VETERAN
ACTIVE WARTIME OR CAMPAIGN BADGE VETERAN
ARMED FORCES SERVICE MEDAL VETERAN
RECENTLY SEPARATED VETERAN
- DATE OF DISCHARGE FROM ACTIVE DUTY:
I am a protected veteran, but I choose not to self-identify the classifications to which I belong.
I am NOT a protected veteran.
I prefer not to answer.
Name:
Employee ID#:
If you are a disabled veteran it would assist us if you tell us whether there are accommodations we could make that would enable you
to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the
way the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist
us in making reasonable accommodations for your disability.
Submission of this information is voluntary and refusal to provide it 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.
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.
A copy of the employment preference for veterans policy -DC-LEGAL is available @ http://www.alvincollege.edu/About/
Policy Manual/D. Personnel/DC/DC (Legal)
__________________________ __________________
Voluntary Self-Identification of Disability
Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2020
Page 1 of 2
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 lim
ited to:
Blindness
Deafness
Cancer
Diabetes
Epilepsy
Autism
Cerebral palsy
HIV/AIDS
Schizophrenia
Muscular
dystrophy
Bipolar disorder
Major depression
Multiple sclerosis (MS)
Missing limbs or
partially missing limbs
Post-traumatic stress disorder (PTSD)
Obsessive compulsive disorder
Impairments requiring the use of a wheelchair
Intellectual disability (previously called mental
retardation)
Please check one of the boxes below:
☐
YES, I HAVE A DISABILITY (or previously had a disability)
☐
NO, I DON’T HAVE A DISABILITY
☐
I DON’T WISH TO ANSWER
Your
Name
Today’s Dat
e
i
Voluntary Self-Identification of Disability
Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2020
Page 2 of 2
Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities.
Please tell us i
f 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 obl
igations 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.
PLEASE NOTE: The EMAIL button may not function in all web browsers. If you experience difficulty with
the email button, PLEASE SAVE OR PRINT IT and return to Office of Human Resources-C132.
Saved forms can be emailed to: HR@alvincollege.edu or faxed to 281-756-3683
Printed forms can be mailed to: Office of Human Resources, 3110 Mustang Road, Alvin, TX 77511
CLEAR FORM
EMAIL FORMS TO HR@alvincollege.edu
SAVE
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 Info Form 2018

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 15 November 2019

Message

View Audit Log
Print With Audit Log
Duplicate Document