Direct Service Position Form - Arizona Department Of Economic Security (Page 2 of 2) in pdf

Direct Service Position Form - Arizona Department Of Economic Security Page 2

ARIZONA DEPARTMENT OF ECONOMIC SECURITY

DIRECT SERVICE POSITION SUPPLEMENT

Explanation

If you have ever been the subject of an investigation of child abuse or neglect in Arizona, or another state or jurisdiction that resulted

in a substantiated (determined to have occurred) finding, you may provide an explanation of the incident of child abuse or neglect. Do

not include the name of any child or any person involved in the investigation. If more space is needed, please attach additional sheets.

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Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans

with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Title II

of the Genetic Information Nondiscrimination Act (GINA) of 2008, the Department prohibits discrimination in admissions,

programs, services, activities, or employment based on race, color, religion, sex, national origin, age, disability, genetics and

retaliation. The Department must make a reasonable accommodation to allow a person with a disability to take part in a program,

service or activity. For example, this means if necessary, the Department must provide sign language interpreters for people who are

deaf, a wheelchair accessible location, or enlarged print materials. It also means that the Department will take any other reasonable

action that allows you to take part in and understand a program or activity, including making reasonable changes to an activity. If

you believe that you will not be able to understand or take part in a program or activity because of your disability, please let us know

of your disability needs in advance if at all possible. To request this document in alternative format or for further information about

this policy, contact 602-771-2870; TTY/TDD Services: 7-1-1. Free language assistance for DES services is available upon request.

Direct Service Position Form - Arizona Department Of Economic Security Page 2