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Job Application​Production Worker

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Piso de cemento

Why are you being asked to complete this form?

The law requires us to provide equal employment opportunities to qualified individuals with disabilities. We have a goal that at least 7% of our workforce consists of persons with disabilities. Additionally, the law mandates us to measure our progress toward this objective. To do so, we must ask applicants and employees if they have a disability or have ever had one. Since disabilities can occur, we must ask this question at least every five years.

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Completing this form is voluntary, and we hope that you choose to do so. Your response is confidential, and no one involved in hiring decisions will see it. Your decision to complete the form and your response will not disadvantage you in any way.

How do you know if you have a disability?

A disability is a condition that may limit one or more of your "major life activities." If you have or have ever had such a condition, you are considered a person with a disability. These conditions include, but are not limited to:

  • Disorder due to alcohol or substance use (currently not using illegal drugs)

  • Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS

  • Blind or low vision

  • Cancer (past or present)

  • Cardiovascular or heart disease

  • Celiac disease

  • Cerebral palsy

  • Deafness or severe hearing difficulty

  • Diabetes

  • Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders.

  • Epilepsy or other seizure disorder

  • Gastrointestinal disorders, e.g., Crohn's disease, irritable bowel syndrome.

  • Intellectual or developmental disability
    Mental health conditions, e.g., depression, bipolar disorder, anxiety disorder, schizophrenia, post-traumatic stress disorder

  • Missing or partially missing extremities

  • Mobility impairment, which benefits from the use of a wheelchair, scooter, walker, leg braces and/or other supports.

  • Nervous system condition, e.g. migraines, Parkinson's disease, multiple sclerosis (MS).

  • Neurodivergence, e.g., attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, and other learning disabilities.

  • Partial or complete paralysis (any cause)

  • Pulmonary or respiratory conditions, e.g., tuberculosis, asthma, emphysema.

  • Short stature (dwarfism)

  • Traumatic brain injury

Work History

Present or Most Recent Employer

Thank you for applying.

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