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Personal Information

Work History

List your full employment record starting with your most recent or current employer.

However, if you upload a resume with the details of your employment history, this step will be completed.

Education

List all High Schools, Trade Schools, or Colleges/Universities you have attended.

Voluntary Self-Identification of Veteran Status

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.

For more information on protected veterans and classifications of protected veterans, please visit: https://www.dol.gov/agencies/ofccp/vevraa/self-id-form

Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended.

The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?

We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years.

Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, 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?

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:

• Autism
• Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS
• Blind or low vision
• Cancer
• Cardiovascular or heart disease
• Celiac disease
• Cerebral palsy
• Deaf or hard of hearing
• Depression or anxiety
• Diabetes
• Epilepsy
• Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome
• Intellectual disability
• Missing limbs or partially missing limbs
• Nervous system condition for example, migraine headaches, Parkinson’s disease, or Multiple sclerosis (MS)
• Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression

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.

Equal Employment Opportunity (EEO-1)
Employee Self-Identification Form

he Equal Employment Opportunity Commission (EEOC) requires organizations with 100 or more employees to complete an EEO-1 report each year. Your employer invites you to self-identify gender and race/ ethnicity. Completion of this data is VOLUNTARY and will not affect your opportunity for employment, or terms or conditions of employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records only accessed by Human Resources. When reported, data will not identify any specific individuals.

Please Read and Initial The Following Statements

If you have any questions regarding any of these statements, ask a Human Resources Representative prior to initialing and signing this application. Your initials and signature verify that you have read, understand, and agree to abide by these statements.

• I hereby certify that all statements made on, or in connection with, my application are true, complete and correct to the best of my knowledge. I understand that any misstatements or omissions of facts on my application or during my interview will be cause for disqualification, or if hired, termination of employment.
• I authorize you to conduct a criminal background check, and to communicate with persons listed as references, former employers, and any others with whom you desire to check. I agree to hold such persons harmless with respect to any information they may give about me.
• I understand that I will be required to successfully pass a pre-employment physical and a drug and alcohol test to gain employment, and I may also be randomly subjected to said testing as a condition of continuing employment at JWF Industries. By submitting this Application for Employment, I hereby consent to said tests.
• If employed, I agree to engage in no outside activity which would involve a material conflict of interest with, or which could reflect adversely on JWF Industries. I understand this decision is to rest with JWF Industries. I agree to hold in strictest confidence any information concerning JWF Industries, its Insureds, and its Agents which may come to my knowledge.
• I understand that completion of this Application for Employment does not guarantee that JWF Industries will employ me. JWF Industries is an "at-will" employer and I understand that my employment and compensation can be terminated, with or without notice, at any time, at the option of either JWF Industries or myself. If I am employed, I agree to conform to the employment policies of JWF Industries; I understand that no representative of JWF Industries, other than the Owner, has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.