Employment Application

Name

This field is for validation purposes and should be left unchanged.

Personal Information

As an equal opportunity employer, we will not unlawfully discriminate against any applicant because of race, sex, sexual orientation, gender identity, religion, color, national origin, ancestry, protected veteran status, age, disability, pregnancy, genetic information or any other factor protected by law. As such, we are an equal opportunity employer of minorities, women, protected veterans and person with disabilities.

Position Applying for

Name*

First Middle Last

Address*

Street Address City State ZIP Code

Email Address*

Telephone*

Social Security Number*

Referred by*

Please specify*

Have you ever filed an application with us before?*

Yes

No

Date*

Have you ever been employed with us before?*

Yes

No

Date*

Do any of your relatives work here?*

Yes

No

Name and relationship*

Are you currently employed?*

Yes

No

If yes, may we contact your present employer?*

Yes

No

Are you legally eligible for employment in the USA?*

(If hired, you are required to submit proof of your eligibility to work in the USA)

Yes

No

Are you over the age of eighteen?*

Yes

No

Date Available for Work*

What is your desired salary range?*

Are you available to work:*

Full-Time

Part-Time

Shifts available to work:*

First Shift

Second Shift

Third Shift

Employment History

List below present and past employment, beginning with your most recent.

Previous Employers

I have no previous employers to list.

Previous Employers

Company Name	Actions

There are no Employers.

Comments

Include explanation of any gaps in employment

Education

School(s)

School Type	Name of School	Years Completed	Diploma/Degree	Actions

There are no Schools.

Describe any specialized training, apprenticeship, skills, job-related extra-curricular activities, or any other additional information you feel may be helpful to us in considering your application:

Describe any job-related training received in the United States military:

Additional Information

Personal/Professional References*

Do not include relatives or former employers

Name

Address

Phone Number

Occupation

Upload Your Resume

Upload your resume in .pdf, .doc or .docx format

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Did someone assist with completion of this application, such as an interpreter, teacher, counselor, etc?*

Yes

No

Name*

Address*

Relationship to applicant*

Phone Number*

Pre-Offer Invitation to Self-Identify

1. This employer is a Government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs or Veterans Act of 2002, 38 U.S.C 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:

A “disabled veteran” is one of the following:
- 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
- A person who was discharged or released from active duty because of a service connected disability.
A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service.
An “active duty wartime or campaign badge veteran” means a 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.
An “Armed forces service medal veteran” means a 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.

Protected veterans may have additional rights under USERRA-the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor’s Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.

2. If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

3. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended.

4. The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

5. This contractor and subcontractor shall abide by the requirements of 41 C.F.R 60-300.5(a). This regulation prohibits discrimination against qualified protected veterans, and requires affirmative action by covered prime contractors and subcontractors to employ and advance in employment qualified protected veterans.

Self-Identification*

I identify as one or more of the classifications of protected veteran listed above

I am not a protected veteran

Voluntary Self-Identification of Disability

Form CC-305 | OMB Control Number 1250-0005 | Expires 04/30/2026

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.

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.

How do you know if you have a disability?

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:

Alcohol or other substance use disorder (not currently using drugs illegally)
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
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

Please check one of the boxes below:

Yes, I have a disability, or have had one in the past

No, I do not have a disability and have not had one in the past

I do not want to answer

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.

Applicant's Initials*

Date*

Personal Information

Employment History

Education

Additional Information

Applicant Data Record

Pre-Offer Invitation to Self-Identify

Voluntary Self-Identification of Disability