Voluntary Self-Identification of Disability
Form CC-305 | OMB Control Number 1250-0005
Page 1 of 1 | Expires 04/30/2026
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. We have a goal of having at least 7% of our
workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask
applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask the question at least every five years.
Completing this form is voluntary,
and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form
and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s
Office of Federal Contract Compliance Programs (OFCCP) website at
www.dol.gov/ofccp
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:
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Alcohol or other substance use disorder (not currently using drugs illegally)
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Autoimmune disorder, for example, lupus, fibromyalgia,
rheumatoid arthritis, HIV/AIDS
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Blind or low vision
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Cancer
(past or present)
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Cardiovascular or heart disease
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Celiac disease
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Cerebral palsy
- Deaf or serious difficulty hearing
- Diabetes
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Disfigurement, for example, disfigurement cased by burns, wounds, accidents, or congenital disorders
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Epilepsy
or other seizure disorder
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Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
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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
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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, dyspaxia, other learning disabilities
- Partial or complete paralysis (any cause)
- Pulmonary or respiratory conditions, for example tuberculosis, asthma, emphysema
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Short stature (dwarfism)
- Traumatic brain injury
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Please check one of the boxes below:
