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Employment Record

(Previous 10 years including years of self-employment)


Employment Record


Employment Record


Employment Record

Voluntary Information

As an employer with an Affirmative Action Program, we comply with government regulations, including Affirmative Action Responsibilities where they apply. In an attempt to judge the effectiveness of our recruitment efforts, we request that you provide the following information. This information, will in no way, be used in the decision to hire or promote.


"Qualified individuals with disabilities, shall not solely by reason of their disability be excluded from participation in, or be denied the benefits of, or be subjected to discriminaion under any program or activity." (Section 504 of the Rehabilitation act of 1973 29 U.S.0 706 ) (8), 794. In accordance with proceeding and Section 1630.4 EEOC Americans with Disabilities Act Employment Regulations. WINGRA invites applicants for employment to indicate whether they are disabled and to what extent, they are disabled. The following information is intended for employment record processing purposes only and should only be provided to WINGRA on a voluntary basis. This information will be kept in strict confidence and will be used in accordance with the applicable laws. Refusal to provide the information on this page will not subject you to any adverse treatment.


In accordance with EEOC Americans with Disabilities Act Regulations, 1630.2 (g) and Section 504 of the Rehabilitation Act of 1973, a "Disabled Person" is defined as any person who:
1. Has a physical or mental impairment which substantially limits one or more major life activities.
2. Has a record of such and impairment.
3. Is regarded as having such an impairment.


 I feel I do qualify as an individual with a disability. I do not qualify as an individual with a disability.

For applicants that feel that they qualify as an individual with a disability, what special assistance or modifications would help you compete in the employment process? (sign language, interpreter, special aids or equipment, etc.)

Driving and Equipment Operation Record

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