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The following questions are to ensure EEOC compliance and are strictly voluntary. We maintain this data for EEOC inquiries and to assist in any discrimination investigations by the federal, state and local governments.
Form CC-305
OMB Control Number 1250-0005
Expires 05/31/2023

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?
We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years.

Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, 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?
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:

  • 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:

Disability self-identification answer

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

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.

Form CC-305
OMB Control Number 1250-0005
Expires 05/31/2023

Invitation to Self-Identify as a Veteran

This employer is a Government 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 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.

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.

Self-identification answer
Pre-Employment Statement :

I hereby affirm that the information on this employment application form/questionnaire and on my resume is true and complete to the best of my knowledge. I understand and agree that falsified information or omissions may result in the termination of any discussion concerning employment with FGS, LLC (FGS), the rescinding of any employment, or termination from employment if discovered after my employment has begun. I further understand that in consideration of FGS's investigation and consideration of my Application for Employment, I agree to waive my rights to a jury trial and will arbitrate with the American Arbitration Association any and all statutory, contractual and/or common law claims or disputes arising between FGS and me in respect to this Application for Employment or consideration of my employment.

I hereby authorize FGS and it's subsidiaries or its appointed investigative agencies to substantiate and verify my past employment, previous salary history, professional credentials, credit standing, academic degrees and any other necessary references. I also authorize my previous schools, employers and listed references to release to FGS, it's subsidiaries or it's appointed investigative agencies, any relevant information, including transcripts that may be required in connection with my employment. If employed, I authorize FGS to release salary and benefit data as well as my resume, employment history and/or employment qualifications to others, as necessary to meet business needs. I agree that FGS and my previous employers, schools and references shall not be held liable if any employment offer is not tendered, is withdrawn, or my employment is terminated due to false or omitted information provided.

If employed by FGS, I understand and agree that such employment is subject to the security policies of the Company. I further understand that if the position for which I am hired requires access to classified information and I am not able to obtain the required security clearance within a period of time specified by my supervisor, I will not be allowed to work in the position and my employment with the Company will depend on the availability of a position which does not require a security clearance and for which the Company determines I am qualified.

I understand and agree that any employment offer I might receive is contingent upon my acceptance of the Company's Employee Dispute Resolution Program and execution of the Mutual Agreement to Arbitrate Claims, my passing a drug screening test, and any other conditions specified in my offer letter. I consent to any testing necessary to determine the presence and/or level of drugs in my body other than drugs prescribed for me by a physician. This includes, but is not limited to, random drug testing of me as an employee if performing under a contract which requires grug testing as a condition of performance, or otherwise required by Company policy. In addition, if requested, I consent to taking a Company-paid employment physical examination. I further agree to wear or use, when prescribed by the Company, safety equipment or protective devices and to comply with all health and safety rules and reporting requirements. I agree to abide by the administrative policies and Standards of Business Ethics and Conduct of the Company.

I understand that no statement in this form, related administrative policies, or an offer of employment is to be construed as an employment contract, and that either party, without the others consent, may terminate the employment relationship at any time, for any reason, with or without cause or notice. Any agreement which varies the right of the employee or FGS to terminate the employment relationship at any time, with or without cause or notice, must be set forth in an express written agreement and signed by both the employee and an FGS offer.
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