HomeCareer Form Career Form Careers 1Position and Documents2Voluntary Self-Identification of Disability3EEO Survey Position Applying ForUpload cover letter, resume, and business references in .docx format.(Required)Accepted file types: docx, Max. file size: 100 MB. Additional Files in docx format Drop files here or Select files Accepted file types: docx, Max. file size: 100 MB. Voluntary Self-Identification of Disability Name(Required) First Last Date(Required) MM slash DD slash YYYY Employee ID(if applicable)Why are you being asked to complete this form? We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years. Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. How do you know if you have a disability? A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to: Alcohol or other substance use disorder (not currently using drugs illegally) Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS Blind or low vision Cancer (past or present) Cardiovascular or heart disease Celiac disease Cerebral palsy Deaf or serious difficulty hearing Diabetes Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders Epilepsy or other seizure disorder Gastrointestinal disorders, for example, Crohn’s Disease, irritable bowel syndrome Intellectual or developmental disability Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD Missing limbs or partially missing limbs Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS) Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities Partial or complete paralysis (any cause) Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema Short stature (dwarfism) Traumatic brain injury Please check one of the boxes below(Required) Yes, I have a disability, or have had one in the past No, I do not have a disability and have not had one in the past I do not want to answer JOB SEEKER/APPLICANT EEO AND VETERAN STATUS SURVEY Samtech, LLC, dba Massif, is an equal opportunity/affirmative action employer. As a federal government contractor, we are required to keep records and perform certain analyses of our job seekers by race, ethnicity, gender, and for protected veteran status and individuals with disabilities. The information is treated as confidential and is never used in making an employment decision. Providing the information is voluntary, but for any statistical analysis to be meaningful we must have information on as many job seekers as possible, and it is just as important to collect this information from men and from non-minorities as it is to obtain it from women and minority group members. We appreciate that some job seekers will find this request intrusive. However, we are required by the government to maintain such records and perform such analyses; your cooperation will allow us to be accurate. It is required that you complete the data above the double line. We hope that you will provide the information below the double line; if you do not wish to provide it, please check the “decline to provide” box(es).Name(Required) First Last This field is hidden when viewing the formPosition Applied ForThe following designations are those currently required to be reported by the federal government.Sex(Required)FemaleMaleDecline to disclose information on genderRace and Ethnicity(Required) 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 (includes Jamaican and West Indian). Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) – A person having origins in any of the peoples of Hawaii, Guam, 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, Eskimo or Aleut (Not Hispanic or Latino) – A person having origins in any of the original peoples of North and South America (including Central America), and who maintains a cultural identification through tribal affiliation or community recognition. Two or More Races (Not Hispanic or Latino) – All persons who identify with more than one of the above races Decline to disclose information on race/ethnicity Protected Veteran(Required) Protected Veteran—A person belonging to one of the four categories of veterans defined below Not a protected veteran Decline to disclose information on protected veteran status Protected Veterans categories as defined by federal government regulations: Disabled Veteran—Either (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 Defense, or (2) a person who was discharged or released from active duty because of a service-connected disability. Recently Separated Veteran—A 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. Active Duty Wartime or Campaign Badge Veteran—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 laws administered by the Department of Defense. See http://www.opm.gov/veterans/html/vgmedal2. Armed Forces Service Medal Veteran—A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a U.S. military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985. See http://www.opm.gov/veterans/html/vgmedal2. Massif is a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified Disabled Veterans, Recently Separated Veterans, Active Duty Wartime or Campaign Badge Veterans, and Armed Forces Service Medal veterans. Massif has a written Affirmative Action Program (AAP) for Disabled Veterans, Recently Separated Veterans, Active Duty Wartime or Campaign Badge Veterans, and Armed Forces Service Medal Veterans which is available for inspection. Among other things, the AAP promises that we post our EEO policy statement, review our personnel process, review the physical and mental requirements of our jobs, provide for external and internal dissemination of our EEO policy, and list job vacancies with the state employment service.
