Applicant EEO or Affirmative Action Application

It is the policy of Cascade Regional Blood Services to provide equal employment opportunity to all qualified applicants for employment without regard to race, color, religion, national origin, sex, age, veteran status or disability. Various agencies of the government require employers to invite applicants to identify themselves as indicated below. Completion of this form is voluntary and in no way affects the decision regarding your application for employment. This form is confidential and will be maintained separately from your application form.

  • This company is subject to Executive Order 11246, as amended, which requires Federal contractors to ensure that applicants are employed and that employees are treated during employment without regard to their race, color, religion, sex, or national origin. We are therefore requesting information about the race and gender of our applicants in order to comply with government reporting requirements and in order to ensure equal employment opportunity. OMB control number 1250-0005
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  • This company is also subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment veterans in the following classifications.

    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. If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

  • 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.**

    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 our. 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.

    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
    • Deafness
    • Cancer
    • Diabetes
    • Epilepsy
    • Autism
    • Cerebral Palsy
    • HIV/AIDS
    • Schizophrenia
    • Muscular dystrophy
    • Bipolar disorder
    • Major depression
    • Multiple sclerosis
    • Missing limbs or partially missing limbs
    • Post-traumatic stress disorder
    • Obsessive compulsive disorder
    • Impairments requiring the use of a wheelchair
    • Intellectual disability (previously called mental retardation)

  • 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 information about this form or the equal employment obligations of federal contractors, visit the US Department of Labor's Office of Federal Contact Compliance Programs 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 five minutes to complete.
  • This field is for validation purposes and should be left unchanged.

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