CSUEB Post-Employment Invitation to Self-Identify
Human Resources

California State University, East Bay ("CSUEB") is a Government contractor subject to Section 503 of the Rehabilitation Act of 1973, as amended ("Section 503"), and the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended ("VEVRA"), which require Government contractors to take affirmative action to employ and advance in employment qualified individuals with disabilities and to take affirmative action to employ and advance in employment qualified disabled veterans. In addition, CSUEB is required to comply with federal and state equal employment opportunity laws including, but not limited to: Executive Order 11246, the Americans with Disabilities Act of 1990 ("ADA"), and the California Fair Employment and Housing Act ("FEHA").

As part of our compliance efforts, we need your cooperation in completing this form. Submission of this information is voluntary and no adverse consequences will result from either providing this information or declining to provide it. The information you provide will be kept confidential.


Employee Information

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Gender, Ethnicity, and Race

CSUEB provides equal employment opportunity for all applicants and employees regardless of the following, without limitation: race, color, religion, sex or national origin.

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For multiple ethnicities, separate additional entries with a semicolon (;)

Disability

Disability
(If yes, this does not constitute prima facie evidence of disability or notification for purpose of accommodation)

Confidentiality

Information you submit about your disability will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of individuals with disabilities, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if the condition might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by OFCCP or the Americans with Disabilities Act, may be informed. The information provided will be used only in ways that are not inconsistent with Section 503.


Affirmative Action Program for Individuals with Disabilities

If you are an individual with a disability, we would like to include you under CSUEB's affirmative action program. If you have a disability and would like to be considered under CSUEB's affirmative action program, please tell us. You may inform us of your desire to benefit under the program at this time and/or at any time in the future. This information will assist us in placing you in an appropriate position and in making accommodations for your disability.

I would like to be considered under CSUEB's affirmative action program

Veteran Status

The information provided will be used only in ways that are not inconsistent with the VEVRA. 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 special disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be 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, may be informed.

Veteran Status (check all that apply)

Disabled Veteran

(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

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.

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Armed Forces Service Medal Veteran

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. (For the current list of military operations for which an Armed Forces service medal was awarded, visit the Veterans Services website for updates)


Other Protected Veteran

Veterans 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. (For the current list of campaigns and expeditions for which a campaign badge was authorized, visit the Veterans Services website for updates)


Affirmative Action Program for Disabled Veterans

If you are a disabled veteran, we would like to include you under CSUEB’s affirmative action program. If you would like to be included under CSUEB’s affirmative action program, please tell us. You may inform us of your desire to benefit under the program at this time and/or at any time in the future. This information will assist us in placing you in an appropriate position and in making accommodations for your disability.

I would like to be considered under CSUEB's affirmative action program

Disability/Disabled Veteran Accommodation

If you are an individual with a disability or a Disabled Veteran, it would assist us if you tell us about the accommodations which we could make which would enable you to perform the job properly and safely, including special equipment, changes in the physical layout of the job, elimination of certain non-essential duties relating to the job or other accommodations.

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