Voluntary Self-Identification of Disability
OMB Control Number 1250-0005
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Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified
people with disabilities.[i] 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. If you already work for us, your answer will not be used
against you in any way. Because a person may become disabled at any time, we are required to ask all of our
employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without
fear of any punishment because you did not identify as having a disability earlier.
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:
||Impairments requiring the use of a wheelchair
||Intellectual disability (previously called mental retardation)
|Missing limbs or partially missing limbs
||Multiple sclerosis (MS)
||Obsessive compulsive disorder
|Post-traumatic stress disorder (PTSD)
OMB Control Number 1250-0005
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Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities.
Please tell us if you require a reasonable accommodation to apply for a job or to perform your job.
Examples of reasonable accommodation include making a change to the application process or work procedures,
providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
[i] Section 503 of the Rehabilitation Act of 1973, as amended. For more information about
this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office
of Federal Contract Compliance Programs (OFCCP) 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.
Please Read Before Submitting
I certify that all information is true and complete. I understand that any misleading
or incorrect statements render this application void, and if employed, would be
cause for termination. I hereby authorize Arapahoe Basin Ski Area (the "Company"
or it's designees, to make such investigations and inquiries of my driving record,
employment history, educational background, or criminal conviction history as may
be necessary in arriving at an employment decision. I hereby authorize past employers,
schools, and references named herein to give information in responding to inquiries
in connection with this application. I release said companies, schools or persons
from all liability for issuing this information. If employed, I agree to conform
to the rules and regulations of the company. I understand that my employment can
be terminated, with or without notice at any time, at the option of either the Company
or myself. I hereby authorize the Company to deduct from my final paycheck upon
termination any debts I may owe to the company (including amounts due for lost or
damaged items for which I may be accountable).