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AAP Applicant Information Form

BCM Controls Corporation is an Equal Opportunity Employer. We are a company that values diversity and we actively encourage women and minorities to apply. As required by law, we must record certain information to be made a part of our Affirmative Action Program. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment.

Applicants for employment are invited to participate in the Affirmative Action Program by reporting their status as handicapped, disabled veteran, veteran of the Vietnam era, or other minority. In extending this invitation you are also advised that:

  1. Applicants are under no obligation to respond, but may do so in the future if they choose
  2. Responses will remain confidential within Human Resources
  3. Responses will be used only for the necessary information to include in our Affirmative Action Program.

Please complete the information requested below. Thank you for your cooperation.

Section 1: General Applicant Information
First Name:
Last Name:
Postion Applied For:
Section 2: Please check all that apply (See below for definitions)
Race or Ethnic Identity
 Hispanic (If yes, please select one of the following:)
 Hispanic (White race only)
 Hispanic (All other races)
 American Indian or Alaskan
 Asian
 Native Hawaiian or Pacific Islander
 Black or African American
 White
 I do not wish to Self-Identify
 
How did you hear of our opening?
 Current Employee    Internet    Recruiter  
 Other  Please explain:
Gender
 M     F
**Veteran Status
 Vietnam Era Veteran
 Special Disabled Veteran
 Other Eligible Veteran
**Other
 Individual with Disabilities
  

EEOC RACE/ETHNIC IDENTIFICATION CATEGORIES

American Indian or Alaskan Native - All persons 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.

Asian - All persons having origins in any of the original people 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.

Native Hawaiian or Other Pacific Islander - All persons having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Black or African American - All persons having origins in any of the Black racial groups of Africa.

White - All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.

Hispanic or Latino (All Races) - All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.

Hispanic or Latino (White race only) - A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, and of the White race.

Hispanic or Latino (All other races) - A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin and of any race other than White.

Individual with Disabilities - Defined as a person who (1) has a physical or mental impairment which substantially limits one or more of his or her major life activity(s), (2) has a record of such impairment(s), or (3) is regarded as having such impairment(s). For purposes of this definition, an individual with disability(s) is substantially limited if he or she is likely to experience difficulty in securing, retaining, or advancing in employment because of the disability(s).

Special Disabled Veteran - Defined as a veteran who is entitled to disability 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 (I) rated at 30% or more, or (ii) rated at 10 or 20% in the case of a veteran who has been determined under Section 1506 to have a serious employment disability, or a person who was discharged from active duty because of a service-connected disability.

Veteran of the Vietnam Era - Defined as a veteran who (a) served on active duty in the Republic of Vietnam between February 28, 1961 and May 7, 1975, or (b) served on active duty for a period of more than 180 days, any part of which occurred between August 5, 1964 and May 7, 1975, and was discharged or released therefrom with other than a dishonorable discharge, or (c) was discharged or released from active duty for a service-connected disability if any part of his or her active duty was performed between August 5, 1964 and May 7, 1975.

Other Eligible Veteran - Defined as any veteran who served in a “war” declared by Congress, in a campaign or on an expedition for which a campaign badge, a service medal, or an expeditionary medal has been awarded.