Voluntary Self-Identification of Disability

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. 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 apply 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 anytime, we are required to ask all of our employees to update their information every fiver years. You may voluntary self-identify as having a disability on this without fear of any punishment because you did not identify as having disability earlier.

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:

• 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)

Please check one of the boxes below:
YES, I HAVE A DISABILITY (or previously had a disability)NO, I DON'T HAVE A DISABILITYI DON'T WISH TO ANSWER

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