Please list any academic honors, scholarships, offices held, etc.(Do not list any which reflect your race, color, religion, gender, national origin, age, disabilities or veteran status.)
Describe any specialized training, apprenticeships, licenses or skills.
Have you received any job-related training in the United States Military?
Please give dates and explanation:
Invitation to Identify for Affirmative Action Purposes
As a federal government contractor, our organization is subject to Section 503 of the Rehabilitation Act of 1973, as amended, and Section 402 of the Vietnam Era Veterans Readjustment Assistance Act of 1974, which require government contractors to employ, and advance in employment, qualified handicapped individuals, disabled veterans, and veterans of the Vietnam Era. We are required by federal regulations to report information as requested below. Your contribution of this information is completely voluntary. The information you provide is strictly confidential and will be maintained separate from your personnel file. We are an equal opportunity employer and do not discriminate in hiring or employment on the basis of race, color, religion, sex, national origin, age, disability or any other basis prohibited by federal, state or local law. Questions on this form are not intended to be used for such discrimination.
Would you like to complete the identification form?
Please Check One:
Indicate the appropriate Race/Ethnic Group*:
White Black/African American American Indian or Alaska Native Asian Native Hawaiian or Other Pacific Islander Hispanic or Latino (All Races) Hispanic or Latino (White Races only) Hispanic or Latino (All Other Races)
To Vietnam Era Veterans, Other Eligible Veterans, Special Disabled Veterans and Individuals with
Disabilities (Check all that are applicable):
“Disabled Veterans” are defined as those persons who served in active duty during the Vietnam Era, the Korean Conflict, World War Two, or World War One, and are “capable of performing a particular job with reasonable accommodation to his or her disability” incurred or aggravated in the line of duty.
“Veterans of the Vietnam Era” are defined as those “who served on active duty for more than 180 days between February 28, 1961 and May 7, 1975, and were discharged or released with other than a dishonorable discharge or were discharged or released from active duty for a service-connected disability.”
“Other Veterans” are defined as those who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized.
“Disabled Individual” means any person who has a physical or mental impairment that substantially limits one or more of such person’s major life activities, has a record of such impairment, or is regarded as having such impairment.
How were you referred: Advertisement Employment Agency Recruitment School/College Temporary Agency Employee Referral Government Agency State Job Service Walk-In Other
*Race Identification Definitions
1.) White – A person having origins in any of the original peoples of Europe, North Africa or the Middle East.
2.) Black or African American – A person having origins in any of the Black racial groups of Africa.
3.) Asian – 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, or Vietnam.
4.) American Indian/Alaskan Native – A person having origins in any of the original peoples of North and South American (including Central American) and who maintains tribal affiliation or community attachment.
5.) Hispanic or Latino (All Races) – A person of Cuban, Mexican, Puerto Rican, Central or South American or other Spanish culture or origin regardless of race.
6.) Hispanic or Latino (White Race Only) – A person of Cuban, Mexican, Puerto Rican, Central or South American or other Spanish culture or origin and of the White race.
7.) Hispanic or Latino (All Other Races) - A person of Cuban, Mexican, Puerto Rican, Central or South American or other Spanish culture or origin and of any other race other than the White race.
8.) Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands.
9.) Missing Race or Unknown – Applies to Applicants only, where a resume or application that is screened is received without any racial or ethnic identification and no further contact is made with the applicant.
APPLICANT ACKNOWLEDGEMENT AND AUTHORIZATION
*PLEASE READ CAREFULLY BEFORE SIGNING*
I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery. I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by GRAFIKA COMMERCIAL PRINTING, INC (hereinafter referred to as "GRAFIKA") that such employment with GRAFIKA. is at will, for no specified duration and may be terminated by either GRAFIKA or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of GRAFIKA or its representatives used during the employment process is deemed a contract of employment real or implied. I understand that no representative of GRAFIKA except the President has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the President of GRAFIKA. In consideration for employment with GRAFIKA, if employed, I agree to conform to the rules, regulations, policies and procedures of GRAFIKA at all times and understand that such obedience is a condition of employment. I understand that due to the nature of GRAFIKA business, attendance and punctuality are considered essential requirements of every job at GRAFIKA and that poor attendance or tardiness will result in disciplinary action. I understand that if offered a position with GRAFIKA, I may be required to submit to a pre-employment medical examination, drug screening and background check as a condition of employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employments tests and checks will result in withdrawal of any employment offer or termination of employment if already employed. I herby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to GRAFIKA and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information. I understand that this application is considered current for six months. If I wish to be considered for employment after this period I must fill out and submit a new application.
I understand that if I am offered a job, regardless of intended payroll status, I must successfully undergo drug screening as part of pre-employment processing (post offer). I acknowledge that my employment offer is contingent upon my favorable test results and that a proper form of ID will be needed at the time of the test. I acknowledge that if I fail the test, my future applications may not be considered up to 1 year after the date of the test.
BY CHECKING THE BOX BELOW I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.
Applicant Full Name:
Name and number of person completing this form if other than applicant:
GRAFIKA COMMERCIAL PRINTING, INC. IS PROUD TO BE AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, DISABILITY, VETERAN STATUS OR ANY OTHER STATUS PROTECTED BY LAW.