First Name * Last Name * Email * Phone * Resume/CV (pdf only) * School * Degree * LinkedIn Profile Website Will you now, or in the future, require employer visa sponsorship (e.g., H-1B)? * Please Select Yes No To help us assess any potential export control restrictions, please indicate if you’ve ever been a citizen of any of the following countries: Iran, Syria, N. Korea, Cuba, China, Venezuela, or Crimea. * Please Select Yes No I certify that the information and supporting documents provided are true and correct. I understand that any false or misleading representations will be grounds for non-hire or termination at any time during my employment. * Are you currently authorized to work in the United States? * Please Select Yes, I have US work authorization as a US Citizen Permanent Resident/Green Card Holder Yes, I have US work authorization via a non-immigrant visa (H-1B, L-1, F-1 OPT or CPT, TN, E-3, O-1, Dependent Visa, Employment Authorization Document/EAD, etc No, I am not currently authorized to work in the United States
For government reporting purposes, we ask candidates to respond to the below self-identification survey. Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.
We do not discriminate on the basis of any protected group status under any applicable law.
Gender Please Select Male Female Other Decline to Self Identify Are You Hispanic/Latino? Please Select Yes No Decline To Self Identify
If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. Classification of protected categories is as follows:
A "disabled veteran" is one of the following: 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 a person who was discharged or released from active duty because of a service-connected disability.
A "recently separated veteran" means 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.
An "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.
An "Armed forces service medal veteran" means a 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.
Veteran Status Please Select I am not a protected veteran I identify as one or more of the classifications of a protected veteran I don't wish to answer
OMB Control Number 1250-0005
Voluntary Self-Identification of Disability
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 involved in making personnel decisions. Completing the form will not negatively impact you in any way.
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:
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS
Blind or low vision
Cardiovascular or heart disease
Cardiovascular or heart disease
Deaf or hard of hearing
Depression or anxiety
Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome
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
Disability Status Please Select Yes, I have a disability, or have a history/record of having a disability No, I don't have a disability, or have a history/record of having a disability I don't wish to answer
1Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form, visit the U.S. Department of Labor's 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.