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.

Old Pueblo Community Services is a Government contractor subject to 60-300.44(a) VEVRAA) which requires Government contractors to take affirmative action to employ and advance veterans in employment. VEVRAA prohibits discrimination and requires affirmative action in all personnel practices regarding protected veterans. The statute covers disabled veterans, Armed Forces service medal veterans, recently separated veterans, and other veterans who served during a war, or in a campaign or expedition for which a campaign badge has been authorized. If you are a disabled veteran, recently separated veteran, other protected veteran, or Armed Forces service medal veteran, we would like to include you under our affirmative action program. If you would like to be included under the affirmative action program, please tell us; §60-300.2 Definitions. • Disabled veteran means:(1) 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 (2) A person who was discharged or released from active duty because of a service-connected disability. • Recently separated veteran means a pre-JVA veteran during the one-year period beginning on the date of the pre-JVA veteran's discharge or release from active duty. • 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. • Armed Forces service medal veteran means any 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 (61 FR 1209). • You may inform us of your desire to benefit under the program at this time and/or at any time in the future. • 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 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 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 OFCCP, or enforcing the Americans with Disabilities Act, as amended, may be informed. • If you are a disabled veteran it would assist us if you tell us about (i) any special methods, skills, and procedures that qualify you for positions that you might not otherwise be able to do because of your disability so that you will be considered for any positions of that kind, and (ii) any accommodations that would enable you to perform the job, including special equipment, changes in the physical layout of the job, elimination of certain duties relating to the job, provision of personnel assistance services or other accommodations. This information will assist us in placing you in an appropriate position and in making accommodation for your disability. A written copy of the Affirmative Action Program for Veterans and Individuals with Disabilities is available for inspection by any employee or applicant for employment, during normal business hours 8:00 am to 5:00 pm, in the Human Resources office. Interested persons should contact Jeanie Pike, Human Resources Director at 520-445-7085.