Voluntary Self – Identification of Disability and EEO Reporting

1.Modern Plumbing Industries, Inc.is a federal contractor required to take affirmative action to employ and advance in employment protected veterans pursuant to the Act.

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.

How do I know if I 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:
• Blindness
• Autism
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)
• Deafness
• Cerebral palsy
• Major depression
• Obsessive compulsive disorder
• Cancer
• HIV/AIDS
• Multiple sclerosis (MS)
• Impairments requiring the use of a wheelchair
• Diabetes
• Schizophrenia
• Missing limbs orpartially missing limbs
• Intellectual disability (previously called mentalretardation)
• Epilepsy
• Muscular dystrophy

2.It is the policy of Modern Plumbing Industries, Inc. to provide equal employment opportunities to all qualified applicants for employment without regard to race, color, religion, national origin, sex, age, veteran status, disability, or any other class protected by federal, state, county, or local regulations. Various agencies of the government require employers to invite applicants to identify themselves as indicated below. Completion of this form is voluntaryand in no way affects the decision regarding your application for employment. This form is not used for employment decisions and will be maintained in a confidential fileseparate from your application form and/or personnel file.

Disabled Veteran means: (i) 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 (ii) A person who wasdischarged or released from active duty because of a service-connected disability.

Special Disabled Veteran means: (i) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt f military retired pay would be entitled to compensation) under laws administered by the Department of Veterans' Affairs for a disability (A) rated at 30 percent or more, or (B) rated at 10 or 20 percent in the caseof a veteran who has been determined under Section 38 W.S.C. 3106 to have a serious employment handicap or (ii) a person who was discharged or released from active duty because of a service-connected disability.

Veterans of the Vietnam Era means: a person who (i) served on active duty in the U.S. military, ground, naval or air service for a period of more than 180 days, and who was discharged or released there from with other than a dishonorable discharge, if any part of such active duty was performed: (A) In the Republic of Vietnam between February 28, 1961, and May 7, 1975, or (B) Between August 5, 1964 and May 7, 1975 in all other cases; or (ii) was discharged or released from active duty in the U.S. military, ground, naval or air service for a service-connected disability, if any part of such active duty was performed (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in any other location.

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 (61 FR 1209, 3 CFR, 1996 Comp., p. 159).

Recently Separated Veteran means: any veteran who served on active duty in the U.S. military, ground, naval or air service during the one-year period beginning on the date of such veteran's discharge or release from active duty.

Other Protected Veteran means 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, other than special disabled veterans or veterans ofthe Vietnam Era

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