Invitation to Self Identify

Applicant Invitation to Self-Identify

Perry Johnson Registrars, Inc. (“PJR”) is subject to Executive Order 11246, as amended, which requires federal government contractors to ensure that the applications process and all employment decisions are based on factors other than race, color, religion, sex, or national origin. We are therefore requesting information about the race and sex of our applicants in order to comply with government reporting requirements and in order to ensure equal employment opportunity.

PJR is also subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended, and section 503 of the Rehabilitation Act of 1973 which requires federal government contractors to take affirmative action to employ and advance in employment covered veterans and qualified individuals with disabilities. If you are a covered veteran or a qualified individual with disabilities (see definitions below) and would like to be considered under the affirmative action program, please tell us. You may inform us of your desire to benefit under the program at this time or at any time in the future.

Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will only be used in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, the Rehabilitation Act of 1973, Executive Order 12985, and Executive Order 11246, as amended. This information will be maintained separately from your application for employment.

* Indicates required field.

First Name:

Last Name:

Position Applied for*:

MaleFemale
White (not Hispanic or Latino)Black or African American (not Hispanic or Latino)Hispanic or LatinoAsian (not Hispanic or Latino)American Indian/Alaska Native (not Hispanic or Latino)Native Hawaiian /Pacific Islander (not Hispanic or Latino)Two or more races (not Hispanic or Latino)
DISABLED INDIVIDUAL (MENTAL OR PHYSICAL) A person who has a mental or physical impairment that substantially limits one or more major life activities, who has a record of such impairment, or who is regarded as having such impairment.DISABLED VETERAN (1) 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 (2) A person who was discharged or released from active duty because of a service-oriented disability.RECENTLY SEPARATED VETERAN 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.ARMED FORCES SERVICE MEDAL VETERAN Any veteran who while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operations to which an Armed Forces service medal was awarded pursuant to Executive Order 12985(61 FR 1209)OTHER PROTECTED VETERAN A veteran who served on active duty in the U.S. military, ground, naval or air service on active duty in a campaign or expedition for which a campaign badge has been authorized, under the laws administered by the department of defense.
For Office Use Only:
Job Group: Location:
160161