Form 138 - Employment Application Page 4

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Voluntary Self-Identification of Disability
Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2017
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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.
 
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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
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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.
Form #138 (revised 2/29/2016)
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