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Former Fed Gov't Work?:
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Top Secret/SCI with FS Poly
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Lao Democratic Republic
Papua New Guinea
Saint Vincent Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
Social Security Number:
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State Workforce Agency
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Have you ever applied for employment at CALVERT?
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Are you age 18 or older?:
Note: If under 18, hire is subject to verification that you are of minimum legal age.
I am authorized to work in this country for any employer
I am authorized to work in this country for my present employer only
I require sponsorship to work in this country
My status to work in this country is unknown
Are you a U.S. citizen?:
Highest Education Level:
High School Diploma / GED
Some college courses and no degree
Trade or Technical School Diploma
References (no family members):
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Voluntary Equal Opportunity Questionnaire
INVITATION TO SELF IDENTIFY: APPLICANTS AND/OR CURRENT EMPLOYEES
This Company is an entity subject to Executive Order 11246; Section 503 of the Rehabilitation Act of 1973, as amended; the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended; the Jobs for Veterans Act (JFVA) of 2003, and/or Title VII of the Civil Rights Act of 1964 and is required to comply with certain government record-keeping requirements.
. THIS FORM IS VOLUNTARY AND COMPLETION IS NOT REQUIRED FOR (CONTINUED) EMPLOYMENT
We hope you will voluntarily complete this form and assist in our affirmative action efforts.
This data is for periodic government reporting and will be kept in a file separate from your application and/or human resources file. Government agencies require periodic reports on the sex, race/ethnicity, disability and veteran status of applicants and employees. This data is for analysis and affirmative action only. Submission of any of the requested information is voluntary.
White (not Hispanic or Latino)
Black or African American (not Hispanic or Latino)
Hispanic or Latino
Native Hawaiian or Other Pacific Islander (not Hispanic or Latino)
Asian (not Hispanic or Latino)
American Indian or Alaska Native (not Hispanic or Latino)
Two or More Races (not Hispanic or Latino)
Race missing or unknown
I decline the invitation to self-identify
PRE-OFFER, VOLUNTARY INVITATION TO SELF IDENTIFY IN ACCORDANCE WITH VEVRAA 41 CFR 60-300.42(a)
This employer is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002,
38 U.S.C. 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:
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
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 (1) 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 or (2) served on active duty during World War II, the Korean conflict, the Vietnam era, and the Persian Gulf War, which is defined as August 2, 1990, to the present (and was not dishonorably discharged).
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 awarded pursuant to
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.
We invite you to complete the VOLUNTARY self-identification fields below and assist in our affirmative action efforts used for compliance with federal government regulations and record-keeping guidelines. This data is for periodic government reporting and will be kept in a file separate from your application and/or human resources file.
Recently Separated Veteran
Active-Duty Wartime Veteran
Campaign Badge Veteran
Armed Forces Service Medal Veteran
None of the Above
I decline the invitation to self identify
Form CC-305, OMB Control Number 1250-0005, Expires 1/31/2020
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 input is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. Why are you being asked to complete this section?
If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability without fear of any punishment because you did not identify as having a disability earlier.
How do I know if I have a disability? 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, but are not limited to:
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)
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 section or employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.
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.
Candidate Individual with disabilities:
Yes, I have a disability (or previously had a disability)
No, I don't have a disability
I don't wish to answer