Form Cc-305 - Confidential Voluntary Questionnaire (Page 3 of 4) in pdf

Form Cc-305 - Confidential Voluntary Questionnaire Page 3

Volunta ry Self-Ide ntificati on of Disabili ty

Form

CC-305

0MB Contro’ Number 1250-0005

Expires

1)3112017

Page 2 of 2

Reasona ble 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.

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 US. Department of Labor’s Office of Federal Contract

Compliance Programs (OFCCP) website at ww.v.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 0MB

control

number. This survey should take about 5

minutes to complete.

Form Cc-305 - Confidential Voluntary Questionnaire Page 3