Employment Application - City Of Newport (Page 7 of 9) in pdf

Employment Application - City Of Newport Page 7

Voluntary Self-Identification of Disability

Form CC-305

OMB Control Number 1250-0005

Expires 1/31/2017

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.

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 Labor’s Office of Federal Contract

Compliance Programs (OFCCP) website at

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.

Employment Application - City Of Newport Page 7