This employment application is for:

Personal Information

* indicates required field.   December 6, 2022

  Yes   No

(If hired, proof of citizenship or immigrant status will be required as mandated by law.)

  Yes   No

If Yes, please explain.

  Yes   No

If Yes, please explain.

  Yes   No

If Yes, name & relationship.

Education and Training

Yes   No

Yes   No

Yes   No

Yes   No

Employment History

List all present and past employment, beginning with your most recent employer.
Current/Most Recent Employer

  Yes   No

Next Previous Employer

  Yes   No

Next Previous Employer

  Yes   No


Only .pdf, .doc, .docx, .rtf, .txt, .odt, and .wps files will be accepted. Upload limit is 4 MB.

Professional References

Affirmative Action: Voluntary Self-Identification Form — Pre-Employment

CCAT is an Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. As required by law, we must record certain information to be made a part of our Affirmative Action Program. When reported, data will not identify a specific individual.

In extending this invitation, you are advised that: (a) individuals are under no obligation to respond, but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for the necessary information to include in our Affirmative Action Program.

We are a company that values diversity. We actively encourage women, minorities, veterans and individuals with disabilities to apply. Refusals to provide this information will have no bearing on your employment and will not subject you to any adverse treatment.

Please complete the information requested below. Thank you for your cooperation.

  •   I understand the reason for this request for voluntary self-identification as stated above and choose to decline.
  •   I understand the reason for this request for voluntary self-identification as stated above and have opted to complete this form.


  •   Male
  •   Female


A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

  •   Yes
  •   No
  •   — A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
  •   — A person having origins in any of the black racial groups of Africa.
  •   — A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
  •   — A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
  •   — A person having origins in any of the original peoples of North or South American (including Central America), and who maintain tribal affiliations or community attachment.
  •   — All persons who identify with more than one of the above races).

Veteran Status

  •   I am not a protected veteran.
  •   I am a protected veteran (includes any veteran who served on active duty in the U.S. military, ground, naval or air service in a war, campaign or expedition in which a campaign badge has been authorized under laws administered by the Department of Defense).

Voluntary Self-Identification of Disability

Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2017

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilitiesi. 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.

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
  • 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)

  •   Yes, I have a disability (or previously had a disability)
  •   No, I don't have a disability
  •   I don't wish to answer

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

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.

Please Read the Following Paragraphs Carefully

By checking the box below, I certify that I have read, understand and agree to each of the following statements:

  • I certify that all of the information furnished on this application and during the application process is true, complete and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts called for will result in refusal to hire or, if hired, will result in my dismissal at any time regardless of when the false answer or omissions are discovered.
  • I recognize that this employment application is not an offer of employment. I further agree that if I am hired by CCAT, I will be an at-will employee, which means that either the Company or I may end my employment at any time with or without cause or notice. I agree that no written materials or verbal statement by CCAT will constitute an express or implied contract of continued employment.
  • I understand that if I am offered employment, in consideration of my employment, I agree to abide by all CCAT rules, regulations, policies and procedures and I understand that CCAT alone has complete discretion to modify such rules and regulations at any time.
  • I understand that if I am offered employment, I may be required to sign confidentiality, non-disclosure, non-solicitation and/or inventions agreements, as a condition of the employment.
  • I understand that CCAT may share the information contained in this application with other CCAT employees for employment and administrative purposes and hereby consent to such transfer of information.
  • I hereby authorize CCAT to conduct any necessary investigation regarding my background as it relates to the position I am seeking and to the extent permitted by federal, state, and local law. I agree to complete the requisite authorization forms for the background investigation. I hereby release all parties from any liability in connection with the provision and use of such information.
  • I agree to submit to legally permissible drug and/or alcohol testing and/or pre-employment physical examinations upon request by CCAT. I understand that CCAT has a drug-free workplace and a drug testing program consistent with applicable federal, state and local laws. I understand that if I am offered a conditional offer of employment, the offer may be withdrawn if a pre-employment drug test is positive. I recognize that the results of these tests may be used to determine my employment or continued employment.
  • I understand and expressly agree that if employed by CCAT, storage areas provided for me (locker, desk, computer, etc.) are open to investigation by CCAT without prior notice to me.