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Application Date: January 15, 2021
(If hired, proof of citizenship or immigrant status will be required as mandated by law.)
If Yes, please explain.
If Yes, name & relationship.
Only .pdf, .doc, .docx, .rtf, .txt, .odt, and .wps files will be accepted. Upload limit is 4 MB.
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.
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
OMB Control Number 1250-0005
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
Disabilities include, but are not limited to:
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.
By checking the box below, I certify that I have read, understand and agree to each of the following statements: