Self Identification

Motus Recruiting and Staffing, Inc. is an Equal Employment Opportunity Employer. In an effort to comply with requirements regarding government record keeping, reporting, and other legal obligations which may apply, we invite you to complete this Voluntary EEO Self-Identification form. Providing this information is strictly voluntary. Failure to provide it will not subject you to any adverse personnel decision or action. Your cooperation is appreciated.

Gender Identification

• Male
• Female
• Non-Binary
• I prefer not to disclose

Race/Ethnicity Identification

Please mark the option that describes the race/ethnicity category with which your primarily identify:

• Hispanic or Latino: A person of Cuban, Mexican, Chicano, Puerto Rican, South or Central American, or other Spanish culture of origin, regardless of race.
• White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.
• African American or Black (Not Hispanic or Latino): A person having origins in any of the Black racial groups of Africa.
• Asian (Not Hispanic or Latino): 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 Philippine Islands, Thailand, and Vietnam.
• Native Hawaiian or Other Pacific Islander: a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
• American Indian or Alaskan Native: A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
• Two or More Races a person who primarily identifies with two or more of the above race/ethnicity categories.
• I elect not to disclose

Disabilities Self Identification

Why are you being asked to complete this form?

We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. To help us measure our progress, we must ask applicants and employees if they have a disability or have 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. Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years.

How do I know if I have a disability?

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:

Please select one of the options below:

• Yes, I have a disability, or have had one in the past
• No, I do not have a disability or have not had one in the past
• I do not wish to disclose

Protected Veteran Self Identification

This employer is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA). VEVRAA requires Government contractors to take affirmative action to employ and advance in employment protected veterans. To help us measure the effectiveness of our outreach and recruitment efforts of veterans, we are asking you to tell us if you are a veteran covered by VEVRAA. Completing this form is completely voluntary, but we hope you fill it out. Any answer you give will be kept private and will not be used against you in any way.

Categories of Veterans Protected by VEVRAA

1. 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; or a person who was discharged or released from active duty because of a service- related disability.

2. Recently Separated Veteran Any veteran during the 3-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval or air service.

3. Active Duty Wartime or Campaign Badge Veteran A veteran who served on active duty in the U.S. military, ground, naval, or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

4. 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 12985.

I belong to the following classifications of Protected Veterans

Please select one of the options below:

• I identify as one or more of the classifications of Protected Veteran listed above
• I am not a Protected Veteran
• I do not wish to disclose

The submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not consistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended.

The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

Reasonable Accommodation Notice

Consistent with the Americans with Disabilities Act (ADA), it is the policy of Motus to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact Emma Dougherty, Human Resources, at 971-371-3490 or emma@motusrecruiting.com.

For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at https://www.dol.gov/ofccp.

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.

Motus Recruiting & Staffing abides by the policies of 41 CFR Part 60-300 as regulated by OFCCP. These regulations prohibit discrimination against qualified individuals on the basis of protected veteran status or disability, and require affirmative action to employ and advance in employment, all persons regardless of their status, and to base all employment decisions only on valid job qualifications.