Form CC-305 OMB Control Number 1250-0005
Why are you being asked to complete this form?
How do I know if I have a disability?
Reasonable Accommodation Notice
||Post-traumatic stress disorder (PTSD)
||Multiple sclerosis (MS)
||Obsessive compulsive disorder
|Missing limbs or partially missing limbs
||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 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.
Voluntary Self-Identification of Veteran Status:
Towson University is a government contractor subject to the Vietnam Era Veterans'
Act of 1974 (VEVRAA), as amended by the Jobs for Veterans Act of 2002, 38 U.S.C.
4212 (VERAA), which requires government contractors to take affirmative action to
employ and advance in employment:
- disabled veterans
- recently separated veterans
- active duty wartime or campaign badge veterans
- Armed Forces service medal veterans
These classifications are defined 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
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-related
- A "recently separated veteran" is any veteran during the three-year period beginning
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" is a veteran who served on active
duty in the U. S. military, ground, naval or air service during a war, or in a
expedition for which a campaign badge has been authorized under the laws administered
by the Department of Defense.
- An "Armed forces service medal veteran" is a veteran who, while serving on active
in the U.S. military, ground, naval or air service participated in a United States
operation for which an Armed Forces service medal was awarded pursuant to Executive
Protected veterans may have additional rights under USERRA - the Uniformed Services
Employment and Reemployment Rights Act. In particular, if you were absent from employment
in order to
perform service in the uniformed service, you may be entitled to be re-employed
by your employer in the
position you would have obtained with reasonable certainty if not for the absence
due to service. For
more information, call the U.S. Department of Labor's Veterans Employment and Training
(VETS), toll-free at 1-866-4-USA-DOL.
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.
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 consistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974,
Towson University is an equal opportunity/affirmative action employer and has a strong
institutional commitment to diversity. Women, minorities, persons with disabilities
and veterans are encouraged to apply.