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APPLICATION FOR EMPLOYMENT

Neeltran, Inc. employs, trains, promotes and provides other terms and conditions of employment without regard for race, color, religion, national origin, sex, sexual orientation, age, disability, political affiliation, marital status, veteran status, or other characteristics protected by law.

Personal Information
Additional Questions
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Applicant Release And Acknowlegement

Please read and e-sign below to continue.

I am aware that if I receive a verbal offer of employment from Neeltran, Inc., I will be subject to a background check, criminal records review, education verification and drug screen. Should the pre-employment screening results not meet company standards, including failure to disclose, the offer of employment will be rescinded. Should falsified information be discovered after I am already employed with Neeltran, Inc. I understand I would be subject to disciplinary action which could lead to termination of employment. Such courses of action are required to uphold Neeltran Inc.'s high value on trust and honesty.

I agree to cooperate in the above mentioned pre-employment screens and release those parties supplying such information to Neeltran, Inc. from all liability or responsibility with respect to information supplied.

My e-signature below acknowledges that I have read, understand, and agree to the terms of the entire application.

I will be subject to a background check, drug screen and reference check.

Invitation To Self Identify Race, Gender And As a Protected Veteran

To enable us to meet government reporting regulations and maintain an Affirmative Action Plan, Neeltran, Inc. requests that you complete this personal data form. Information will be used solely for government reporting purposes and will be detached and kept separate from your file. Any information that you choose to provide will not be considered by Neeltran, Inc. for employment purposes and will be treated as personal and confidential. Your voluntary cooperation is appreciated.

Gender
Female
Male
Race/Ethnicity

Please check the appropriate box(es) below.

Neeltran, Inc. is a federal 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 contractors to take affirmative action to employ and advance in employment:

  1. Disabled veterans defined as (a) veterans of the U.S. military, ground, naval or air service who are 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 (b) persons who were discharged or released from active duty because of a service-connected disability;
  2. Recently separated veterans defined as any veterans 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;
  3. Active duty wartime or campaign badge veterans defined as veterans 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 the laws administered by the Department of Defense; and
  4. Armed Forces service medal veterans defined as veterans 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.

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. This information is being requested on a voluntary basis and will be kept confidential, consistent with applicable law. Refusal to provide the requested information will not subject you to any adverse treatment. If provided, this information will not be used in a manner inconsistent with VEVRAA.

Voluntary Self-Identification of Disability
Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2017
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 disabilitiesi. 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
  • 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

*Please check one of the boxes below:

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.

i 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.