Employment Form

Have you previously worked for or applied for a position with Intercomp, in any of our locations either as an employee or through an employment agency?

Are you legally authorized to work in the United States?

Do you now or might you in the future need sponsorship for a visa authorizing you to work in the United States?

Pursuant to the Immigration Reform and Control Act of 1986, all applicants who are offered employment must produce documents establishing their identity and authorization for employment in the United States. These documents must be produced no later than seventy-two (72) hours after employment commences. In addition, all new hires will be required to verify their employment authorization under oath by signing INS Form 1-9.

How did you learn about Intercomp?

Please specify your complete full-time and part-time employment history, including self-employment. You may include any verified workperformed on a volunteer basis. Begin with your most recent employer.

Individuals not related to you. Business references preferred.

The information requested below will be used for purposes of our Affirmative Action Program and to comply with certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations and in support of our voluntary EEO and diversity programs.

In order to comply with these laws, we invite employees to voluntarily self-identify their race and ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment.

NOTE: Federal law requires us to maintain a record of each employees sex and race or ethnicity if an employee decides to self identify, we are required to make a best guess as to the employees sex and race or ethnicity based on available information. Because guessing is uncomfortable for all involved, we encourage self-identification.

The information will be confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the government for civil rights enforcement. This information will not be included in your application file.

A person is Hispanic or Latino if he or she is of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish Culture or origin regardless of race.

In what racial/ethnic category do you consider yourself to belong?

White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American. A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander. A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam

American Indian or Alaska Native. A person having origins in any of the original peoples of North America and South America (including Central America), and who maintain tribal affiliation or community attachment.

Two or More Races. All persons who identify with more than one of the above races (White, Black or African American, Native Hawaiian or Other Pacific Islander, Asian, American Indian or Alaska Native). For the purposes of this group, identifying as Hispanic or Latino and only one of the listed 5 race groups does NOT qualify

We are a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C.4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows and are hereafter referred to all together as "protected veterans"

A Disabled Veteran is one of the following:

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 Campaiqn Badqe 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.

If you believe you belong to any of the categories of protected veterans listed above,please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness ofthe outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

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 only in ways that are not inconsistent with VEVRAA as amended. Any answer you give will be kept confidential. We are an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, color,gender, national origin, ancestry, religion, physical or mental disability, age, veteran status, sexual orientation, gender identity, marital status, pregnancy, citizenship, or any other factor protected by anti-discrimination laws.

As part of our commitment to the men and women who serve our country through military service, we also endeavor to support their spouses or partners and families. If you are a spouse or partner of an active duty member of the military services or a protected veteran, we invite you to identify yourself.

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 only in ways that are not inconsistent with VEVRAA as amended. Any answer you give will be kept confidential. We are an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, color,gender, national origin, ancestry, religion, physical or mental disability, age, veteran status, sexual orientation, gender identity, marital status, pregnancy, citizenship, or any other factor protected by anti-discrimination laws.

Why are you being asked to complete this form?
We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workforce be individuals with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years. Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. 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/agencies/ofccp.

How do you know if you have a disability?
A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

• Alcohol or other substance use disorder (not currently using drugs illegally)
• Disfigurement, for example, caused by burns, wounds, accidents, or congenital disorders
• Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s), and/or other supports
• Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
• Partial or complete paralysis (any cause)
• Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
• Short stature (dwarfism)
• Traumatic brain injury
• Missing limbs or partially missing limbs
• Diabetes
• Blind or low vision
• Cancer (past or present)
• Celiac disease
• Intellectual or developmental disability
• Deaf or serious difficulty hearing
• Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS
• Nervous system condition for example, migraine headaches Parkinson's disease, or Multiple sclerosis (MS)
• Epilepsy
• Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome
• Cardiovascular or heart disease
• Cerebral Palsy
• 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. This survey should take about 5 minutes to complete.

APPLICANT’S STATEMENT & ACKNOWLEDGMENT

THIS APPLICATION IS NOT COMPLETE UNTIL IT IS FULLY COMPLETED, SIGNED, ANDALL STATEMENTS BELOW HAVE BEEN READ AND INITIALED.

I have read and fully understand the questions asked in this application. I certify that all of the answers I have given are true, accurate and complete. I understand that the omission and/or misrepresentation of any fact from or on this application or during any interview will result in immediate rejection of my application or if I am hired will be cause for immediate dismissal.

I understand and agree that nothing in this application shall constitute an offer, a contract or a guarantee of employment for a specific period of time.

If hired, I understand that my employment may be terminated with or without cause and with or without notice at any time, at the will of the Company or me. I further understand that no representative or agent of the Company, other than its president or vice president, has the authority to enter into any agreement for employment for any specific period of time, or to make an agreement contrary to the foregoing. I also understand that any agreement modifying my at-will employment status must be in writing and signed by the president or vice president.

I understand that any hiring decision is contingent upon my successful completion of all (if any) of the Company's lawful pre-employment checks.

I agree to execute any consent forms necessary for the Company to conduct its lawful pre-employment checks.