You are applying for

.NET / SQL Developer

Baltimore, MD

Equal Employment Opportunity Self Identification Disclosure Statement

Eliassen Group is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, Eliassen Group invites all applicants to voluntarily self-identify their ethnic origin, veteran status, and disability if applicable. In addition, please detail any reasonable accommodations that may be needed in order to perform essential job responsibilities. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment during the recruiting process. The information obtained will be kept confidential and may 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 federal government for civil rights enforcement. When reported, data will not identify any specific individual.

Please navigate through the following invitations to self identify your ethnic origin, veteran status, and disability. Should you choose not to disclose this information please select the appropriate response to indicate your desire to decline to self-identify.

  • Step 1
    Ethnic Origin
  • Step 2
    Veteran Status
  • Step 3
    Section 503
  • Step 4


  • White (Not Hispanic or Latino): 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 Pacific Islander: A person having origins in any of the original 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 Philippines Islands, Thailand and Vietnam
  • American Indian or Native Alaska: A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
  • Two or more races: A person having a combination of two or more races listed above.
  • Question 1

    Please Check The Ethnic Origin That Best Applies To You.*

    Question 2

    Please Select Your Gender*

  • Recently Separated Veteran: Any veteran during the three-year period beginning on date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval or air service.
  • Active Duty Wartime Veteran: A veteran who served on active duty in the U.S. military, ground, naval or air service during a war.
  • Disabled Veteran: 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. This definition also includes all individuals who were discharged or released from active duty due to a service-connected disability.
  • Armed Forces Service Medal Veteran: 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 No. 12985. To identify the military operations that meet this criterion, check your DD from 214, Certificate of Release or Discharge from Active Duty.
  • Campaign Badge Veteran: A Veteran who has been in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
Question 1

Please Select the Appropriate Response In Regards to Your Veteran Status*


You are being asked to complete this information because we do business with the government, we must reach out 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. 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.

Form CC-305
OMB Control Number: 1250-0005
Expires 01/31/2017

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
  • Deafness
  • Cancer
  • Diabetes
  • Epilepsy
  • Autism
  • Cerebral Palsy
  • Schizophrenia
  • Muscular Dystrophy
  • Bipolar Disorder
  • Major Depression
  • Multiple Sclerosis (MS)
  • Missing limbs or partially missing limbs
  • Post-Traumatic Stress Disorder (PTSD)
  • Obsessive Compulsive Disorder
  • Impairments requiring the use of a wheelchair
  • Intellectual Disability (previously called mental retardation)
Question 1

Please select one of the options below:*

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.

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 as .

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.


Thank you for completing this survey and assisting Eliassen Group with their reporting requirements.

Please understand certain information is REQUIRED by the government for us to report. Should you choose not to self identify certain aspects or all of this survey an Eliassen Group official will report information based on assumption and visual identification for government entities.

To complete this survey please check the box below to indicate your authorization to submit this information. Should you have any questions please do not hesitate to reach out to April Bourque, Human Resources Administrator.

By clicking “SUBMIT” below you are authorizing Eliassen Group to utilize this information for reporting purposes.