Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2020
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. [1]
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 limited 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).
Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to
qualified
individuals with disabilities. Please tell us if 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.
[1] Section 503 of the Rehabilitation Act of 1973, as amended. For
more
information about this form or the equal employment obligations of
Federal
contractors, visit the U.S. Department of Labors Office of Federal
Contract
Compliance Programs (OFCCP) website at www.dol.gov/agencies/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.
