Partner Success Manager

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.

As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA)

• As a recent separated veteran
• As an active duty wartime or campaign badge veteran
• An Armed forces service medal veteran

Self-Identification Survey

Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.

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

To ensure compliance with the Americans with Disabilities Act (ADA), we ask that you indicate whether you consider yourself to have a disability. Please select all that apply:

• Able-bodied
• Blind or low vision
• Cancer (past or present)
• Cardiovascular or heart disease
• Celiac disease
• 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

Equal Employment Opportunity Policy

We do not discriminate on the basis of any protected group status under any applicable law.

OMB Control Number 1250-0005

Expires 04/30/2026

Public Burden Statement

This survey should take about 5 minutes to complete.