Candidate Evaluation Form

Personal

U.S. Equal Employment Opportunity Information

Individuals seeking employment are considered without regards to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, or sexual orientation. You are being given the opportunity to provide the following information in order to help us comply with federal and state Equal Employment Opportunity/Affirmative Action record keeping, reporting, and other legal requirements.

Completion of the form is voluntary. Refusal to provide the requested information will not subject you to any adverse treatment. Any information that you do provide will be kept confidential as required by law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.

We endeavor to 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.

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:

-Blindness

-Autism

-Bipolar disorder

-Post-traumatic stress disorder (PTSD)

-Deafness

-Cerebral palsy

-Major depression

-Obsessive compulsive disorder

-Cancer

-HIV/AIDS

-Multiple sclerosis (MS)

-Impairments requiring the use of a wheelchair

-Diabetes

-Schizophrenia

-Missing limbs or partially missing limbs

-Intellectual disability (previously called mental retardation)

-Epilepsy

-Muscular dystrophy

Work History (Last 3 Years)