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INVITATION TO SELF-IDENTIFY

This employer is a government contractor subject to the regulations enforcing Executive Order 11246, antidiscrimination laws and 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). As such, this employer is required to ask employees to provide their race, gender, and veteran information so that we can monitor our compliance under the regulations. Providing this information is strictly voluntary. Failure to provide it will NOT subject you to any adverse employment action. This page will be detached from your application/personnel file and will be confidentially maintained in a separate folder.
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Voluntary Self-Identification of Disability

Form CC-305
OMB Control Number 1250-0005
Page 1 of 2

Why are you being asked to complete this form?

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 form 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.

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 on this form 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:

  • 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)
    		•

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    Voluntary Self-Identification of Disability

    Form CC-305
    OMB Control Number 1250-0005
    Expires 1/31/2020
    Page 2 of 2

    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 form or the equal 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.

    APPLICATION FOR EMPLOYMENT

    We are an Equal Opportunity Employer. Applicants are considered for employment without regard to race, color, religion, sex, national origin, sexual orientation, marital status, age, disability, and veteran or citizenship status. Employment with our company is at the will of the employee and the employer. In order to be considered for employment, this application must be fully completed.

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    Description / Requirements: Minimum: 2 years’ steel fabrication shop or industrial paint/blast experience. Preferred: 5 years’ steel fabrication shop paint/blast experience spraying sophisticated coatings.
    Description / Requirements: Minimum: 3+ years’ experience as a fitter in a steel fabrication job shop requiring proficient blueprint reading and interpretation skills, accurate use of various measuring instruments, and good applied shop mathematics skills. Preferred: 5+ years’ experience as a fitter in a steel fabrication job shop fabricating complicated steel structures such as moveable bridges, miter gates, tainter gates, ball mill shells, etc..
    Description / Requirements: Minimum: 2 years’ machining experience in a machine job shop and/or an Associate's Degree in Machine Tool Technology. Preferred: 5 years’ machining experience in a machine job shop and an Associate's Degree in Machine Tool Technology.
    Description / Requirements: Minimum: Strong background in PLC's, variable speed drives, CNC machinery and overhead crane repair (electrical and mechanical) with degree or extensive documented experience and training.
    Description / Requirements: Minimum: 3 years’ CNC machine operator experience in an industrial environment and/or an Associate's Degree in Machine Tool Technology. Preferred: 5+ years’ Steel Prep CNC machinery operator experience in a steel fabrication job shop.
    Description / Requirements: Minimum: 2 years’ MIG welding experience in an industrial environment and/or an Associate’s Degree in Welding Technology. The ability to pass welding certification test(s) within the allotted time. Preferred: 5 years MIG welding experience in a steel fabrication job shop welding partial-pin, full-pin and/or submerged arc MT, PT, UT and/or RT tested welds.
    Description / Requirements: Minimum: SNT-TC-1A Level I MT, PT and/or UT Certification and previous experience performing dimensional inspection to tight tolerances. Good oral and written communication skills. Preferred: CWI and/or SNT-TC-1A Level II MT, PT & UT with dimensional inspection experience in a Steel Fabrication Job Shop and/or a Machining Job Shop. Excellent oral and written communication skills.
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    Address History

    Previous Addresses During the Last Three Years

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    Record of Employment

    List All Additional Employment in the final text area.

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    Education and Training

    Please list all high schools, colleges, and special courses attended, time at each and grades completed. Also list any professional designations or professional courses completed.

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    Job Information

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    DISCLOSURE STATEMENT

    This company does not discriminate in hiring or any employment practice on the basis of race, color, religion, sex, national origin, sexual orientation, ancestry, age, or citizenship status nor does this company discriminate against any employee or candidate for employment because of veteran status or physical or mental disability. No question on this application is intended to secure information to be used for such discrimination. If you feel that you have been discriminated against in any prohibited manner during the selection process, please ask to speak to someone in Human Resources in order for the matter to be investigated further.

    STATEMENT OF AGREEMENT

    I certify that the answers given herein and during an interview are true and complete to the best of my knowledge. I authorize the investigation of all matters contained in this application and hereby give the employer permission to contact schools, previous employers, references, and all others, and hereby release the employer from any liability as a result of such contact, unless otherwise noted in this application. I understand that misrepresentation, omissions of facts, or incomplete information requested in this application may remove me from further consideration for employment or may result in dismissal should I be employed.

    I hereby acknowledge that I have read the foregoing statement and understand the contents.

    It is agreed and understood that this Application for Employment in no way obligates this company to employ me and that any offer of employment is subject to the terms and conditions stated on this application form. I agree and understand that my employment is for no definite duration and may be terminated at will by either the company or me. It is agreed and understood by me that participation in any of the benefits programs of this company does not create a contract of employment. Additionally, any statements in the Company’s employee handbook does not create a contract, the employee handbook should not be construed as a contract and cannot create a contract of employment for any definite duration. I agree and understand that only the President has the authority to establish a contract of employment with me and that any such contract must be in writing, designated as an employment contract, and signed by both parties.

    If required for the position for which I am applying, I will consent to a post offer pre-employment physical examination and blood or urine analysis at the company’s expense. (Note: this analysis may test for controlled substances.) I understand that if I falsify responses to medical inquiries, including my history of worker’s compensation claims, I may be terminated from employment and precluded from receiving worker’s compensation benefits and/or unemployment benefits. Further, I understand that any employee or former employee who makes knowingly false or fraudulent material statements or misrepresentation for the purpose of obtaining worker’s compensation benefits may be guilty of felony.

    If hired, I pledge to abide by the company’s policies concerning equal employment opportunity and prohibition of unlawful harassment. Further, I promise to immediately report any violation of such policies in the manner set forth in those policies.

    In the event of my employment, any company materials entrusted to me during the course of my employment will be returned to the company on the last day of my employment, whether I resign or am terminated. I agree and understand, that should I be employed, I will not at any time or in any manner, either directly or indirectly, divulge, disclose or communicate to any person, firm or corporation in any manner whatsoever any confidential information concerning any matters affecting or relating to the business of the Employer, including, without limiting the generality of the foregoing, any of its customers, its services or products, its manner of operation, its plans or other “proprietary information.” I understand that I may be asked to sign a confidentiality agreement consistent with this paragraph as a condition of employment.

    I understand that this application will only remain active for consideration for 60 days.

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