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Make sure to click on the back or next buttons to save your progress.

Make sure to click on the back or next buttons to save your progress.

Make sure to click on the back or next buttons to save your progress.

 Why are you being asked to complete this form? 

Because we are a sponsor of a registered apprenticeship program and participate in the National Registered Apprenticeship System that is regulated by the U.S. Department of Labor, we must reach out to, enroll, and provide equal opportunity in apprenticeship to qualified people with disabilities.[1] To help us learn 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 apprenticeship, any answer you give will be kept private and will not be used against you in any way. 

If you already are an apprentice within our registered apprenticeship program, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our apprentices at the time of enrollment, and then remind them yearly, that they may update their information. 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. 

 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: blindness, deafness, cancer, diabetes, epilepsy, autism, cerebral palsy, HIV/AIDS, 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, and intellectual disability (previously called mental retardation). 

Your Right to Equal Opportunity: It is against the law for a sponsor of an apprenticeship program registered for Federal purposes to discriminate against an apprenticeship applicant or apprentice based on race, color, religion, national origin, sex, sexual orientation, age (40 years or older), genetic information, or disability. The sponsor must ensure equal opportunity with regard to all terms, conditions, and privileges associated with apprenticeship. If you think that you have been subjected to discrimination, you may file a complaint within 300 days from the date of the alleged discrimination or failure to follow the equal opportunity standards with U.S. Department of Labor, Office of Apprenticeship, 200 Constitution Ave NW, Washington, DC 20210. You may also be able to file complaints directly with the EEOC, or State fair employment practices agency. If those offices have jurisdiction over the sponsor/employer, their contact information is listed below. EEOC: https://publicportal.eeoc.gov/Portal/Login.aspx; Call 1–800–669–4000 (toll free) 1–800–669–6820 (TTY) 1–844–234–5122 (ASL video phone); Visit an EEOC field office (information at www.eeoc.gov/field-office); E-Mail info@eeoc.gov. NEOC: Branch Office 1313 Farnam on-the-Mall, Omaha, Nebraska 68102-1836 Telephone (402) 595-2028 1-800-382-7820 www.neoc.ne.gov; IOCR: 6200 Park Avenue, Suite 100, Des Moines, IA 50321-1270, 515-281-4121, https://icrc.iowa.gov/ Each complaint filed must be made in writing and include the following information: 1. Complainant's name, address and telephone number, or other means for contacting the complainant; 2. The identity of the respondent (i.e. the name, address, and telephone number of the individual or entity that the complainant alleges is responsible for the discrimination); 3. A short description of the events that the complainant believes were discriminatory, including but not limited to when the events took place, what occurred, and why the complainant believes the actions were discriminatory (for example, because of his/her race, color, religion, sex, sexual orientation, national origin, age (40 or older), genetic information, or disability); 4. The complainant's signature or the signature of the complainant's authorized representative.