Job Application

Voluntary Race/Gender Self-Identification

Success for All Foundation, Inc. is subject to Executive Order 11246, which requires government contractors to ensure nondiscrimination and take affirmative action in employment to employ and advance qualified individuals without regard to sex, gender identity, sexual orientation, race, color, religious creed, and national origin. As a government contractor, we are required to report certain data regarding our applicants and employees to the government.

In order to comply with these requirements, we are required to ask you if you want to provide information regarding your gender, race, and ethnicity. In answering the questions regarding your race/ethnicity, please use the race/ethnicity definitions established by the federal government listed below. Submission of this information is voluntary, and failure to provide it will not subject you to any adverse treatment. The information provided will be maintained confidentially and used only in ways that are consistent with applicable law. Your cooperation is appreciated.

Voluntary Veteran Self-Identification

Success for All Foundation, Inc. is a Government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended (VEVRAA) which requires government contractors to take affirmative action to employ and advance in employment:

1. Disabled Veterans;
2. Recently separated Veterans;
3. Active duty wartime or campaign badge Veterans; and
4. Armed Forces service medal Veterans

These classifications are defined as follows:

• A “disabled Veteran” is one of the following:
  • 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 Veterans Affairs; or
  • A person who was discharged or released from active duty because of a service-connected disability
• A “recently separated Veteran” means any 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
• An “active duty wartime or campaign badge Veteran” means 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 the laws administered by the Department of Defense
• An “Armed Forces service medal Veteran” means a Veteran 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. Your Form DD-214 may help you make this determination. 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. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be maintained confidentially and used only in ways that are consistent with VEVRAA.

If you are a disabled Veteran, please let us know if there are any reasonable accommodations we could make that would enable you to be considered for a job opening or perform the essential functions of the position you hold. We consider requests for accommodation on a case-by-case basis.

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.

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
• Epilepsy
• Schizophrenia
• Muscular dystrophy
• Missing limbs or partially missing limbs
• Intellectual disability (previously called mental retardation)

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.