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New Employee/Student Self-Identification Form

July 2017

The bylaws accepted by the Associated Master Plumbers of Allegheny County (AMPAC) state that it is a charitable organization (educational) that is open to persons of all races, colors, nationalities, and ethnicity.
As part of this acceptance, Federal laws and regulations require us to report on our workforce by race, gender, and veteran status and to offer the opportunity for self-identification as to disabilities. Please assist us by completing this form. YOU ARE NOT REQUIRED TO PROVIDE THIS INFORMATION. Data which you provide shall be kept strictly confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled individuals and/or disabled veterans; (ii) first aid and safety personnel may be informed, to the extent appropriate, if the condition might require emergency treatment; and (iii) governmental officials reviewing the Company’s compliance status shall be informed.

Article from AMPAC Bylaws
The Associated Master Plumbers of Allegheny County admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admission policies, scholarship and loan programs, and other school administered programs.

A voluntary self-identification form is listed on the opposite side of this page. If there are any questions/concerns about the completion of this form, please discuss the form with any member of the AMPAC staff, board of directors, or teachers.
Tick all that apply

* Categories consistent with 41 C.F.R. §60-300 & Form VETS-100A
+ If you need a definition of these terms, please see below.

SELF-IDENTIFICATION FORM DEFINITIONS:

1. The term “Disabled Veteran” means –
   A. 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 Department of Veterans Affairs for a disability; or
   B. A person who was discharged or released from active duty because of a service-connected disability.

2. The term “Recently Separated Veteran” applies to any veteran during the three-year period beginning on the date of discharge or release from active duty.

3. An “individual with a disability” means any person who (i) has a physical or mental impairment which substantially limits one of more of such person’s major life activities; (ii) has a record of such impairment; or (iii) is regarded as having such impairment.