Manager, Learning & Development Performance and Insights

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Self-Identification Survey

Do you consider yourself a person with a disability? Yes No Not sure

If you answered yes to the previous question, please select all that apply:

• Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
• Blind or low vision
• Cancer (past or present)
• Cerebral palsy
• Deaf or serious difficulty hearing
• Diabetes
• Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
• Epilepsy or other seizure disorder
• Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
• Intellectual or developmental disability
• Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
• Missing limbs or partially missing limbs
• Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
• Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
• Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
• Partial or complete paralysis (any cause)
• Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
• Short stature (dwarfism)
• Traumatic brain injury

Why did you complete this form?

To comply with the requirements of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, we must gather information about the disability status of our employees and applicants. This information helps us ensure that we are providing equal employment opportunities and meeting our goal of having at least 7% of our workforce as people with disabilities.

What is the purpose of this survey?

The purpose of this survey is to gather information about the disability status of our employees and applicants. This information helps us ensure that we are providing equal employment opportunities and meeting our goal of having at least 7% of our workforce as people with disabilities. The information collected is confidential and will not be used in any way to affect your employment status.

Who is required to complete this survey?

As a federal contractor or subcontractor, we are required to provide equal employment opportunity to qualified people with disabilities. We must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

What happens after I complete this survey?

After you complete this survey, your response will be recorded and maintained in a confidential file. Your answer will not be shared with anyone who makes hiring decisions. Your decision to complete the form and your answer will not harm you in any way.

For more information about the law or this form, 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.