• 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)

41 CFR 60-300.42(a)

We are a government contractor subject to the Vietnam Era Veteran's Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 USC 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: (1) 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 (2) 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 award pursuant to the 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.

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.

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 Veteran's Readjustment Assistance Act of 1974, as amended.

The information you submit will be kept confidential, except that (1) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (2) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (3) 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.

Our policy is to provide equal employment and advancement opportunities to all qualified individuals. To achieve this goal, we are dedicated to taking affirmative action to employ and advance in employment qualified protected veterans at all levels of employment, including the executive level. All personnel actions, including recruitment, hiring, compensation, benefits, training and promotion of persons in all job titles are administered without regard to veteran status, and all employment decisions are based solely on valid job requirements.

As an Equal Opportunity Employer. As required by law, we are required by law to record certain information to be made part of our Affirmative Action Program. Applicants for employment are also invited to participate in the Affirmative Action Program by reporting their status under protected categories. In extending this invitation you are also advised that: (a) workers (applications) are under no obligation to respond, but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for the necessary information to include in our Affirmative Action Program. We are a company that values diversity. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment.

Please complete the information requested below. Thank you for your cooperation.

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guan, Samoa, or other Pacific Islands.

Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

Sources:

Equal Opportunity Employment Commission, Standard Form 100 http://www.eeoc.gov/eeo1survey

U.S Department of Labor Employment Law Guide http://www.dol.gov/compliance/guide/vietvets.htm

I certify that my answers are true and complete to the best of my knowledge. I hereby authorize Veracity Engineering to thoroughly investigate my background, references, employment record, and other matters related to my suitability for employment. I authorize persons, schools, my current employer(if applicable), and previous employers and organizations contacted by Veracity Engineering to provide any relevant information regarding my current and/or previous employment and I release all persons, schools, and employers of any and all claims for providing such information. I understand that misrepresentation or omission of fact may result in rejection of this application or if hired, discipline up to and including dismissal. I understand that I may be required to sign a confidentiality and/or non-compete agreement should I become an employee of Veracity Engineering. I understand that nothing contained in this application, or conveyed during any interview that may be granted is intended to create an employment contract.

I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future and acknowledge that any employment relationship with Veracity Engineering is of an "at will" nature in which either party is free to terminate for any reason. It is further understood that this "at will" employment relationship may not be changed by a written document or by conduct unless such a change is specifically acknowledged in writing by authorized office of Veracity Engineering.

I have read and understand the above Agreement. This application is complete and accurate to the best of my knowledge.