U.S. Equal Opportunity Employment Information (Completion is voluntary)
Individuals seeking employment at Mic are considered without regards
to race, color, religion, national origin, age, sex, marital status, ancestry, physical
or mental disability, veteran status, gender identity, or sexual orientation. You are
being given the opportunity to provide the following information in order to help us
comply with federal and state Equal Employment Opportunity/Affirmative Action record
keeping, reporting, and other legal requirements.
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.
Please select Male
Decline To Self Identify
Are you Hispanic/Latino?
Please select Yes
Decline To Self Identify
Please identify your race
Please select American Indian or Alaskan Native
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
Two or More Races
Decline To Self Identify
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 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.
Please select I am not a protected veteran
I identify as one or more of the classifications of a protected veteran
I don't wish to answer
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
1. 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:
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 select 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
1Section 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.