Post-Offer Voluntary Self-Identification Form printable pdf download

POST-OFFER VOLUNTARY SELF-IDENTIFICATION

NAME:

_________________________________________________________________

Last

First

Middle Initial

Our organization is committed to the employment and advancement of qualified minorities,

females, individuals with disabilities and veterans. If you fall into one of these protected

classifications, we invite you to identify yourself. You may inform us of your desire to benefit

under the program at this time and/or any time in the future. This information will assist us in

placing you in an appropriate position and in making accommodations for your disability.

Instrument & Valve Services supports EEO/AA in all aspects of employment including, but

not limited to, applicants, promotions, training, transfers, retention and termination.

Instrument & Valve Services establishes and monitors AA goals and takes proactive measures

throughout the year to advance these goals and to ensure equal employment opportunity (EEO)

for all.

The information provided will be kept confidential except that: (1) supervisors and managers

may be informed regarding work restrictions and regarding necessary accommodations; (2) first-

aid safety personnel may be informed, when and to the extent appropriate, if the condition might

require emergency treatment; and (3) government officials investigating compliance may be

informed.

We would like to include you under Instrument & Valve Services AA Program. If you are a

protected veteran or a disabled individual, it would assist us if you tell us about: (i) any special

methods, skills, and procedures that would qualify you for a position you might not otherwise be

able to do because of your disability so that you will be considered for any positions of that kind,

and (ii) accommodations we could make to enable you to perform the job properly and safely,

including special equipment, changes in the physical layout of the job, elimination of certain

duties relating to the job, provision of personal assistance services, or other accommodations.

Submission of the above information or if you choose not to answer any questions will not

subject you to adverse treatment.

Our affirmative action plan for disabled individuals, special disabled veterans and other covered

veterans is available for inspection to any employee or applicant for employment upon request.

A copy of the plan may be inspected during normal business hours.

SIGNATURE OF APPLICANT:

________________________________________

POSITION SOUGHT:

________________________________________

DATE:

________________________________________

Post-Offer Voluntary Self-Identification Form