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Voluntary Self-Identification of Disability
Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure 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 a job, any answer you give will be kept private and will not be used against you in any way.
If you already work for us, 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 employees to update their information every five years. 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:
- Cerebral palsy
- 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
- Intellectual disability (previously called mental retardation)
Voluntary Disclosure of Race and Gender
Our company is an equal opportunity employer that supports workforce diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on, race, gender, veteran status, disability or other protected category. To allow our business to evaluate diversity recruiting efforts and comply with regulatory reporting obligations, we collect information about race/ethnicity and gender during our application process. Your cooperation is appreciated in providing the information above, which will be used by our businesses for statistical reporting and any required government reporting.(Responding to this request is voluntary and this information will not be used in assessing your qualifications for any position)
Volunteer Agreement and Release Form
I am aware that volunteering with Chattanooga Goodwill Industries, Inc. involves risks of personal injury, property damage and other risks associated with volunteer service.
I understand that I will not be compensated for my services as a volunteer.
I understand that Chattanooga Goodwill Industries, Inc. is not responsible or liable for my personal effects and property and that they will not provide lock up or offer security for any items.
By my signature, for myself, my estate and heirs, I release discharge, indemnify and forever hold Chattanooga Goodwill Industries, Inc., its employees and Board of Directors harmless from any claims and/or causes of action arising from participation as a volunteer and travel associated therewith.
Tennessee Statutes excludes unpaid volunteers from our Worker’s Compensation coverage. I understand that I will NOT be covered under Chattanooga Goodwill Industries, Inc.’s Worker’s Compensation insurance while performing as a Volunteer. In the event that I am injured, I consent to administration of first aid and other medical treatment and agree to pay the costs of any such treatment.
I understand that I am to abide by whatever policies, rules and regulations currently in effect at Chattanooga Goodwill Industries, Inc. I also understand that volunteer work is based on mutual consent and that either I or Chattanooga Goodwill Industries, Inc. can end the volunteer relationship at any time without notice.
I understand that any confidential information to which I have access is privileged and shall be held in strict confidence. Information will be shared with Chattanooga Goodwill Industries, Inc., staff as necessary. I understand that any violation of the confidentiality of such information may result in termination of my partnership with Chattanooga Goodwill Industries, Inc.
I give any organization involved with Chattanooga Goodwill Industries, Inc. permission to photograph me as it relates to my volunteer work. I understand that the organizations have permission to use these photographs/videotapes for publicity purposes.
By signing, I acknowledge that I have carefully read and fully understand the information, and I am voluntarily signing this agreement between myself and Chattanooga Goodwill Industries, Inc. as you own free act. *
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