EyeCare Partners and it's affiliated companies are an equal opportunity employer. EyeCare Partners does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.
I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for EyeCare Partners to hire me. If I am hired, I understand that either EyeCare Partners or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of EyeCare Partners has the authority to make any assurance to the contrary.
I attest with my typed signature below that I have given to EyeCare Partners true and complete information on this application. No requested information has been concealed. I authorize EyeCare Partners to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.
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I attest that I am not an “Ineligible Person” and that I understand that I must immediately disclose to EyeCare Partners any debarment, exclusion, or suspension. Ineligible Persons includes an individual or entity who is currently excluded, debarred, suspended, or otherwise ineligible to participate in the Federal health care programs or in Federal procurement or non procurement programs; or has been convicted of a criminal offense that falls within the ambit of 42 U.S.C. § 1320a‐7(a), but has not yet been excluded, debarred, or suspended.
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Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation? *
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Are you able to work any shift? *
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Are you able to work overtime, including weekends? *
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Are you eligible to work in the U.S.? *
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Are you at least 18 years or older? (If no, you may be required to provide work authorization to work.) *
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Have you ever been terminated from employment or asked to resign by an employer? *
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How did you hear about this opportunity? *
If referred by a current employee, what is their full name? *
If you have ever been terminated/asked to resign, please provide company name and details. *
LinkedIn Profile
To the best of your knowledge, have you ever worked for our company or affiliated companies? *
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Website
Were you referred by a current employee? *
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What is your desired compensation for this role? *
Voluntary Self-Identification For government reporting purposes, we ask candidates to respond to the below self-identification survey.
Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring
process or thereafter. Any information that you do provide will be recorded and maintained in a
confidential file.
As set forth in Desert Vista Eye Specialist, PC’s Equal Employment Opportunity policy,
we do not discriminate on the basis of any protected group status under any applicable law.
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Race & Ethnicity Definitions
If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.
As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure
the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories
is 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.
Veteran Status
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Why are you being asked to complete this form?
We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.
Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, 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?
A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. 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
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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
Disability Status
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