Are you employed now?
May we inquire of your present employer?
Ever applied to this Company before
If Yes, when and where?
May we inquire of any of your past employers?
Applicants and employees who wish to benefit under the Affirmative Action Program of Pyramid Mountain
Lumber, Inc. are invited to identify themselves. This information is voluntarily provided, it will be kept
confidential, and refusal to provide it will not subject any applicant or employee to any adverse treatment.
Nothing shall preclude employees from informing the company, at a future time, of a desire to benefit under
I IDENTIFY MYSELF AS:
Veteran of the Vietnam Era
A veteran of the Vietnam era who (A) served on active duty for a period of more than 180 days, and was
discharged or released with other than a dishonorable discharge, if any part of the person’s active duty
occurred: (1) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (2) between August
5, 1964, and May 7, 1975, in all other cases; or (B) was discharged or released from active duty for a serviceconnected
disability if any part of the person’s active duty was performed: (1) in the Republic of Vietnam
between February 28, 1961, and May 7, 1975; or (2) between August 5, 1964, and May 7, 1975, in all other
Special Disabled Veteran
(1) A veteran 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 Veterans Administration for a disability: (A) rated at
30% or more, or (B) rated at 10 or 20% in cases of a veteran who has been determined under Sect. 1506 of
Title 38 USC to have a serious employment handicap; (2) A person who was discharged or released from
active duty because of service-connected disability.
Other Protected Veteran
A veteran who served on active duty during a war or in a campaign or expedition for which a campaign badge
has been authorized? (Example: World War II, Korean, the Persian Gulf War, Desert Shield, Bosnia, Somalia,
Recently Separated Veteran
A veteran who served on active duty in the United States military, ground, naval, or air service and was
discharged or released from active duty less than three years before today’s date.
Any person who (1) has a physical or mental impairment that substantially limits one or more of such person's
major life activities, (2) has a record of such impairment, or (3) is regarded as having such an impairment. For
purposes of this part, a handicapped individual is "substantially limited" if he or she is likely to experience
difficulty in securing, retaining, or advancing in employment because of a handicap or disability.
This employer is a Government contractor subject to Executive Order 11246, as amended. In accordance with
the Executive Order, we will not discriminate against any employee or applicant for employment because of
race, color, religion, sex or national origin. This Order also requires Government contractors to take affirmative
action to ensure that applicants are employed, and that employees are treated during employment, without
regard to their race, color, religion, sex or national origin.
Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment.
Information you submit will be kept confidential, except that Government officials engaged in enforcing laws
administered by OFCCP may be informed. The information provided will be used only in ways that are not
inconsistent with Executive Order 11246, as amended.
I identify myself as:
Rather Not Say
I identify myself as:
Rather Not Say