Employment Application

Affirmative Action: Voluntary Self Identification Form

Ibis Tek is an equal opportunity employer. As required by law, we must record certain information to be made a part of our Affirmative Action Program. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, age, national origin, genetics, disability, veteran status, or any other classification protected by law. We participate in E-Verify.

Ibis Tek is an EOE/AA/M/F/V/D employer and encourages qualified applicants in all categories including M/F/Vet/Disability categories to apply. If you need assistance in applying due to a disability please contact Human Resources at (724) 431-2341.


Applicants for employment are also invited to participate in the Affirmative Action Program by reporting their status as disabled, disabled veteran, veteran of the Vietnam era or other minority. In extending this invitation you are also advised that: (a) workers (applicants) are under no obligation to respond, but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for the necessary information to include in our Affirmative Action Program. We are a company that values diversity. We actively encourage women and minorities to apply. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment.


Please complete the information requested below. Thank you for your cooperation.

Section 1: General Applicant Information

General Information




Section 2: Please check (4) all that apply

Race or Ethnic Identity (see below for definitions) Gender







EEOC RACE/ETHNIC IDENTIFICATION CATEGORIES

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.
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 (Not Hispanic or Latino)
A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above five races.

Applicant (Pre-Offer) Request for Voluntary Veteran Information

Ibis Tek is an 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 Ibis Tek 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:

Disabled Veteran
Means (i) 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 (ii) a person who was discharged or released from active duty because  of a service connected disability.

Recently Separated Veteran
Any veteran who served on active duty in the U.S. military, ground, naval or air service during the three-year period beginning on the date of such veteran's discharge or release from active duty.

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 the laws administered by the  Department of Defense.

Armed Forces Service Medal Veteran
Includes any 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. 

Protected veterans may have additional rights under USERRA – the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.

If you believe that you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below in Section 2. 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 to (Company) is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with VEVRAA.

In addition, the information that you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs or enforcing the Americans with Disabilities Act, may be informed.

Ibis Tek will maintain a separate file on persons who have self-identified.

Ibis Tek's full Affirmative Action Program for Disabled Workers, Disabled Veterans, Recently Separated Veterans, Active Duty Wartime or Campaign Badge Veterans and Armed Forces Service Medal Veterans, absent the data metrics required by 41 CFR 60-300.44(k), is available upon request. Information about how the AAP can be obtained and reviewed is posted/provided for applicants.

Please check all that apply (See above for definitions)



Section 3: Please check all that apply

Voluntary Self-Identification of Disability

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 disabilities i 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
  • Deafness
  • Cancer
  • Diabetes
  • Epilepsy
  • Autism
  • Cerebral palsy
  • HIV/AIDS
  • Schizophrenia
  • Muscular Dystrophy
  • Bipolar disorder
  • Major depression
  • Multiple sclerosis (MS)
  • Missing limbs or partially missing limbs
  • Post-traumatic stress disorder (PTSD)
  • Obsessive compulsive disorder
  • Impairments requiring the use of a wheelchair
  • Intellectual disability (previously called mental retardation)

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.

Employment Application

Ibis Tek is an equal opportunity employer. As required by law, we must record certain information to be made a part of our Affirmative Action Program. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, age, national origin, genetics, disability, veteran status, or any other classification protected by law. We participate in E-Verify.

Ibis Tek is an EOE/AA/M/F/V/D employer and encourages qualified applicants in all categories including M/F/Vet/Disability categories to apply. If you need assistance in applying due to a disability please contact Human Resources at (724) 431-2341.


Applicant Information














Ibis Tek, Inc. requires proof of citizenship at the time of employment. Ibis Tek, Inc. requires a valid passport or two positive forms of ID. Work eligibility will be verified through the United States Department of Homeland Security's E-Verify program.








Have you ever worked for this company?




Have you ever been convicted of a felony?



Do you have a valid drivers license?
Education





Did you Graduate?








Did you Graduate?






Did you Graduate?



References
Please list three professional references.















Previous Employment










May we contact your previous supervisor for a reference?










May we contact your previous supervisor for a reference?










May we contact your previous supervisor for a reference?
Military Service






Where Did You Hear About Us?

Attach Your Resume
Attach your resume or any other files you'd like to include with your application by clicking the button below, or simply dragging them into this box.

NOTE:
Document sizes are limited to 5mb and must be one of the following file types: pdf, doc, docx, xls, odf, rtf, html.
Also, uploading requires Internet Explorer 8+, Firefox, or Chrome.

Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
(Type Name)

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