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Invitation to Applicants for Voluntary Inclusion in the Phillips Plastics Affirmative Action Plan for Minorities and Women. Phillips Plastics Corporation is committed to a policy of Equal Employment Opportunity and Affirmative Action under applicable federal and state laws. As part of this commitment and as a matter of law, we must keep records of the gender and race/ethnic status of applicants for employment. Please help us fulfill these commitments by providing the information requested below. Providing this information is voluntary. Refusal to provide this information will not result in any adverse treatment. The information provided will be kept separate from your Employment Application and in strict confidence, except that government officials investigating affirmative action program compliance may have access to reported information. Thank you for your cooperation with this important matter.

Regulatory Compliance

For export compliance purposes, applicants of Phillips-Medisize U.S. must be one of the following, as defined under the IRCA and ITAR regulations, to be considered for employment:

  • U.S. Citizen
  • In possession of a valid Green Card (permanent resident)
  • An admitted refugee
  • Granted asylum
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Invitation to Applicants for Voluntary Inclusion in the Phillips-Medisize Affirmative Action Plan for Minorities and Women

Phillips-Medisize Corporation is committed to a policy of Equal Employment Opportunity and Affirmative Action under applicable federal and state laws. As part of this commitment and as a matter of law, we must keep records of the gender and race/ethnic status of applicants for employment. Please help us fulfill these commitments by providing the information requested below. Providing this information is voluntary. Refusal to provide this information will not result in any adverse treatment. The information provided will be kept separate from your Employment Application and in strict confidence, except that government officials investigating affirmative action program compliance may have access to reported information. Thank you for your cooperation with this important matter.

Invitation to Self-Identify

(a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race)

Pre-Employment request for Veteran Classification

Phillips-Medisize is a Government contractor 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: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) 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 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.

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 reemployed 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 Service (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.

Please check one of the boxes below:

Voluntary Self-Identification of Disability
Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2017
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.i 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:

  • Blindness
  • Deafness
  • Cancer
  • Diabetes
  • Epilepsy
  • Autism
  • Cerebral palsy
  • HIV/AIDS
  • Schizophrenia
  • Muscular dystrophy
  • Bipolar disorder
  • Major depression
  • 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 check one of the boxes below:

 

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 specialized equipment.

i 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.

 

 

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