Application Form

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investgation of all statements herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice.

Disclosure and Release Form

The Equal Employment Opportunity Commission (EEOC) requires all private employers with 100 or more employees as well as federal contractors to invite applicants to self-identify gender and race and complete and EEO-1 report each year. Completion of this form is voluntary and will not affect your opportunity for employment, or the terms or conditions of your employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records only accessed by the Human Resources department, except where a disability is identified in accordance with federal law, the following personnel & officials will have access to it:

• Supervisors or others who need to be informed in order to assess requests for & implement any necessary restrictions of work duties and/or necessary accommodations
• Proper personnel, to the extent appropriate, if the disability might require emergency treatment
• Government officials investigating compliance with the Americans with Disabilities Act or the laws administered by the Office of Federal Contract Compliance Programs

We must reach out to, hire, and provide equal opportunity to qualified people with disabilities. 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 is voluntary. If applying for a job, any answer you give will be kept private and will not be used against you.

If you already work for us, your answer will not be used against you. 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.

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits life activity, or if you have a history or record of such an impairment or medical condition.

Disabled Veteran:
(a) 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 (b) a person who was discharged or released from active duty because of a service-connected disability.)

Recently Separated Veteran:
(Veteran who served on active duty in the U.S. military, ground, naval or air service during the three-year period beginning on the date of such veteran’s discharge or release from active duty.)

Active Duty Wartime or Campaign Badge Veteran:
(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:
(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.)