Dental Technician- Finishing Department

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 anyway. It is not viewed or used as apart of the recruiting or hiring process. It will be used only for Equal Employment Opportunity reporting and statistical purposes.

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 anyway. It is not viewed or used as apart of the recruiting or hiring process. How Do You Know if You Are a Veteran Protected by VEVRAA (Vietnam Era Veterans’ Readjustment Assistance Act of 1974)? Contrary to the name, VEVRAA does not just cover Vietnam Era veterans. It covers several categories of veterans from World War II, the Korean conflict, the Vietnam era, and the Persian Gulf War which is defined as occurring from August 2, 1990 to the present. If you believe you belong to any of the categories of protected Veterans listed, please indicate by selecting the appropriate option below.  Veteran Status (required)--  What Categories of Veterans Are “Protected” by VEVRAA? “Protected” veterans include the following categories; (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These categories are defined below. A “disabled veteran” is one of the following: 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; A person who was discharged or released from active duty because of a service-connected disability. A “recently separated veteran” means any veteran during the three-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. An “active duty wartime or campaign badge veteran” means 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. An “Armed forces service medal veteran” means 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. Protected veterans may have additional rights under USERRA - the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll- free, at 1-866-4-USA-DOL. If you believe you belong to any of the categories of protected Veterans listed above, please indicate by selecting the appropriate option below. We request this information to measure the effectiveness of the outreach and positive recruitment efforts.

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 anyway. It is not viewed or used as apart of the recruiting or hiring process. How do you know if you have a disability? A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to: Alcohol or other substance use disorder (not currently using drugs illegally), Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS Blind or low vision Cancer (past or present) Cardiovascular or heart disease Celiac disease Cerebral palsy Deaf or serious difficulty hearing Diabetes Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders Epilepsy or other seizure disorder Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome Intellectual or developmental disability Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD Missing limbs or partially missing limbs Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities Partial or complete paralysis (any cause) Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema Short stature (dwarfism), Traumatic brain injury.

We will consider applicants for this position without regard to any category protected by applicable federal, state or local law, including but not limited to: race, color, religion, sex, national origin, age, physical or mental disability, genetic information, veteran status or uniformed servicemember status. By submitting your application you hereby certify that the facts set forth in the above employment application are true and complete to the best of your knowledge. I certify that the facts set forth in this employment application and attached application materials including but not limited to my resume, are complete, true, and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for this position or if hired, disciplinary action up to and including discharge regardless of the timing or circumstances of discovery of the falsification, misrepresentation, or omission. I understand that submission of an application does not guarantee employment. I understand that none of the documents, policies, procedures, actions or statements of BDL or its representatives used during the employment process is deemed a contract of employment, real or implied. I understand that as part of the hiring process and where permitted by federal, state, and; or local law the company may wish to obtain "consumer reports" as part of a background investigation. If applicable and permitted by law, I understand BDL will provide me with separate written notification of this intent and I agree to complete any requisite authorization forms. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employment tests checks will result in withdrawal of any employment offer or termination of employment if already employed. BDL IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. IF HIRED, I UNDERSTAND THIS MEANS THAT EITHER BDL OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT NOTICE OR CAUSE. FURTHER, NO EMPLOYEE OR REPRESENTATIVE OF BDL IS AUTHORIZED TO ENTER INTO AN AGREEMENT, EXPRESS OR IMPLIED, WITH ME OR ANY OTHER APPLICANT FOR EMPLOYMENT FOR A SPECIFIED PERIOD OF TIME UNLESS SUCH AN AGREEMENT IS IN A WRITTEN CONTRACT SIGNED BY THE CO-OWNERS OR HUMAN RESOURCES OF BDL. I authorize the company to confirm all statements in this application and; or on my resume as it relates to the position and to the extent permitted by applicable law. I authorize any and all schools, former employers, references, courts, and any others who have information about me to provide such information to BDL. I understand that the information may include but is not necessarily limited to performance evaluations and reports, job descriptions, disciplinary reports, letters of reprimand, and opinions regarding my suitability for employment possessed by it. I hereby release the company and its authorized representatives to verify all information provided by me. I hereby release any party contacted by this employer including persons, schools, organization or former employers to disclose such information from any liability, claims, charges or causes of action which may result of the delivery or disclosure of requested information except for the malicious and willful disclosure of derogatory facts concerning my employment made for the express purpose of preventing me from obtaining employment which the party disclosing such facts knows are untrue. I have read all of the information contained in this application form and Acknowledgements.