Technical Solutions Architect - Davidson, NC or Home Office

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Affirmative Action Voluntary Self Identification Forms

InSource Solutions (the “Company”) is an equal opportunity employer and does not discriminate on the basis of race, color, sex (including pregnancy, sexual orientation, gender identity or transgender status), age, religion, ancestry, national origin, disability, or status protected veteran. As an equal opportunity employer, the Company complies with all relevant government regulations and affirmative action responsibilities. Solely to help us with record keeping, reporting, and other legal requirements, we offer you the opportunity to complete this self-identification form. Submission of this information is voluntary. Whether you provide this information or not, you will not be subject to adverse treatment.

The Company maintains affirmative action plans for persons with disabilities and protected veterans. These plans, or portions thereof, that will enable you to avail yourself of their benefits, are available for inspection by contacting Julie Joyce, Affirmative Action Administrator, during normal business hours.

Please complete all 4 portions. If you choose not to self-identify, please check that box and sign.

Part I: Your Race and Gender

Part 2: Your Veteran Status

DEFINITION OF THE TERMS “PROTECTED VETERAN,” means a veteran who is protected under the nondiscrimination and affirmative action provisions of the Vietnam Veterans’ Readjustment Assistance Act, 38 U.S.C. 4212; specifically a veteran who may be classified as an active duty wartime or campaign badge veteran, disabled veteran, Armed Forces service medal veteran, or recently separated veteran,

Part 3: Do you have a disability?

Because we do business with the government, we are required to, hire, and provide equal opportunity to qualified people with disabilities. 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.

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:

• Autism
• Bipolar Disorder
• Blindness
• Cancer
• Cerebral Palsy
• Deafness
• Diabetes
• Epilepsy
• HIV/AIDS
• Impairments requiring the use of a wheelchair.
• Intellectual disability (previously called mental retardation)
• Major Depression
• Missing limbs or partially missing limbs
• Muscular dystrophy
• Multiple sclerosis (MS)
• Obsessive Compulsive disorder
• Post-traumatic stress disorder (PTSD)
• Schizophrenia

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.

Please contact hr@insourcess.com for assistance.

Part 4: Your Acknowledgement

The provision of this information is on a voluntary basis. This document is maintained in a separate location for affirmative action program use and will not be included in the personnel file of any employee.

I am given the opportunity to participate in the self-identification process:

DISCLAIMER AND SIGNATURE.

PLEASE READ CAREFULLY BEFORE SIGNING. ASK FOR CLARIFICATION IF NEEDED.

InSource is an equal opportunity employer. It is our policy and practice to recruit, employ, train, compensate, promote, appraise, and conduct all other activities relating to our staff without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, gender identity or transgender status), age or disability.

If I am employed by InSource, I will abide by all rules and regulations and all regulatory authorities which have jurisdiction over it. I recognize that InSource may be required by rule or regulation to make certain reports, filings and disclosures to governing bodies. I agree to hold InSource harmless with respect to any information incorporated within such report, filing or other document. I also understand that while employed, if my behavior should raise any question about my physical or mental condition to satisfactorily perform my job responsibilities, I may be required to be tested for the presence of alcohol, drugs, or controlled substances. I understand that all business and client information which comes to my attention is to be strictly confidential and never discussed outside InSource.

This application for employment, the Company’s employee owner’s manual, and any other document, statement or promise either expressed or implied is not to be considered an offer for employment, a contract of employment, a guarantee of continued employment, or a guarantee of wages or benefits. Employment with the company is not for a definite duration and can be terminated by me or by InSource at any time, with or without notice, and for any reason whatsoever. I understand that no manager or representative of the company, other than its president or his/her designee, has any authority to enter any agreement for employment for any specified period of time or make any agreement contrary to the foregoing either now or in the future. I understand that such an agreement must be in writing and signed by the president for it to be binding on either myself or the company, I further understand that this statement supersedes any prior oral or written understanding and bars any future oral understanding to the contrary. If employed, I understand that my terms or conditions of employment may be changed or terminated at the employer’s will.

I certify that all statements on the application are true and complete to the best of my knowledge and I have withheld nothing that would affect my application unfavorably. If employed, I understand any false information, misrepresentation, or omission, whenever discovered, may preclude an offer of employment, may result in the withdrawal of an offer, or may result in my discharge from employment if I am already employed at the time. I acknowledge that I have read the above statements and understand them. I authorize InSource to solicit and obtain from former employers, colleagues, and other persons who know me, information that would be helpful in deciding about my employment.