The U.S. Department of Labor’s Office of Contract Compliance Programs and the Office of Management and Budget have released a new form, which is titled “Voluntary Self-Identification of Disability,” for use by federal contractors and subcontractors when conducting pre-employment disability inquiries pursuant to the revised regulations at 41 C.F.R. 60-741. The purpose of these inquiries is to promote recruitment and hiring of persons with disabilities, including veterans with disabilities. For more information, go to www.dol.gov/ofccp.
The content of the form is as follows:
Voluntary Self-Identification of Disability
Form CC-305 OMB Control Number 1250-0005
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 • Autism • Bipolar disorder • Post-traumatic stress disorder (PTSD) • Deafness • Cerebral palsy • Major depression • Obsessive compulsive disorder • Cancer • HIV/AIDS • Multiple sclerosis (MS) • Impairments requiring the use of a wheelchair • Diabetes • Epilepsy • Schizophrenia • Muscular • Missing limbs or partially missing limbs • Intellectual disability (previously called mental retardation) • dystrophy
Please check one of the boxes below:
Your Name ___________________________________________
Today’s Date _________________________________________
___ YES, I HAVE A DISABILITY (or previously had a disability)
___ NO, I DON’T HAVE A DISABILITY
___ I DON’T WISH TO ANSWER
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.