*Required Fields.
*Applying for:
*First Name
*Last Name
*Address
*City
*State
*ZIP/Postal Code
*Phone
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Attach Resume: We strongly suggest including a resume with your application. To do so simply click the browse button and browse to its location on your computer. Also please note that we only accept the following file types - .txt, .wpd, .doc, .docx, .pdf.
Attach Cover Letter:
What is your current job title?
How long have you held this job?
Briefly describe your current job duties:
Reason for leaving?
Desired Salary:
Our company is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, the company invites employees to voluntarily self-identify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.
PLEASE CHECK ONE:
MaleFemale
Hispanic or LatinoWhite (Not Hispanic or Latino)Black or African American (Not Hispanic or Latino)Asian (Not Hispanic or Latino)Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)American Indian or Alaska Native (Not Hispanic or Latino)Two or More races (Not Hispanic or Latino)
Under the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, (VEVRAA), this employer is required to submit a report identifying veterans in its workforce. Please indicate below if you qualify as a special disabled veteran, a Vietnam era veteran, or a veteran who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized. You may identify yourself as a veteran now or at any time in the future.
Please note that your response is voluntary. Declining to respond will not subject you to any adverse treatment. Information you provide will be kept confidential except where it is required to be disclosed by a civil rights enforcement agency, regulation, or law.
Select all that apply:
Yes, I am a veteran. Date of discharge or release from active duty: Yes, I am a special disabled veteran: a veteran of the U.S. military, ground, naval, or air service who:
is entitled to compensation under the laws administered by the Department of Veterans Affairs for a disability that is:
rated at 30 percent or more, or
rated at 10 or 20 percent if the veteran has been determined by 38 U.S.C 3106 to have a serious employment handicap
would be entitled to such compensation but for the receipt of military retired pay; or
was discharged or released from active duty because of a service-connected disability.
Yes, I am a veteran of the Vietnam era: a veteran who:
served on active duty in the U.S. military, ground, naval, or air service for more than 180 days, was not dishonorably discharged, and served any part of such active duty in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or in any other location between August 5, 1964 and May 7, 1975; or
was discharged or released from active duty in the U.S. military, ground, naval, or air service for a service-connected disability, if any part of such active duty was performed: in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or in any other location between August 5, 1964 and May 7, 1975.
Yes, I am an other protected 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, other than a special disabled veteran or a veteran of the Vietnam era.
No, I am not a veteran.
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