Senior Director, Alliance Management
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
Protected Veterans I am a disabled veteran I am a recently separated veteran I am an active duty wartime or campaign badge veteran I am an armed forces service medal veteranDisability Status
To determine if you are eligible for the goal of having at least 7% of our workers as people with disabilities, we need to know if you have a disability or have ever had one. A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:
- Asthma
- Bipolar disorder
- Celiac disease
- Cerebral palsy
- Chronic obstructive pulmonary disease (COPD)
- Diabetes
- Epilepsy or other seizure disorder
- Fibromyalgia
- Heart disease
- HIV/AIDS
- Lupus
- Migraine headaches
- Multiple sclerosis (MS)
- Narcolepsy
- Neurodevelopmental disorders, including ADHD, autism spectrum disorder, dyslexia, dyspraxia, and other learning disabilities
- Parkinson’s disease
- Post-traumatic stress disorder (PTSD)
- Severe depression
- Sickle cell disease
- Spina bifida
- Stroke
- Systemic lupus erythematosus (SLE)
- Tourette’s syndrome
- Ulcerative colitis
- Uveitis
- Wheezing
If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.
As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.
Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more 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.