Your Current Address

NOTE: Answering “yes” to the following questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. (In answering these questions, do not include minor traffic infractions and convictions for which the record has been sealed or expunged, any conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed, referrals to and participation in any pre-trial or post-trial diversion programs, and marijuana-related offenses that occurred over two years ago.)

Education History

Please list your highest level of education completed and any additional education, training, or certifications relevant to the position.

Work Experience

Please list your full-time and part-time work experience for the past five years, beginning with your current or most recent employer. Include self-employment, temporary assignments, contract work, and staffing agency assignments where applicable. Please provide complete and accurate information to the best of your ability.

Voluntary Equal Employment Opportunity Self-Identification

KVK Tech, Inc. is an Equal Opportunity Employer. We are subject to certain governmental recordkeeping and reporting requirements related to equal employment opportunity. In order to support these requirements, we invite applicants to voluntarily self-identify their sex, ethnicity, and race.

Completion of this section is voluntary. You are not required to provide this information. Refusal to provide this information will not subject you to any adverse treatment and will not affect your opportunity for employment.

The information provided in this section will be maintained separately from your employment application, will be kept confidential to the extent permitted by law, and will not be used in making any hiring decision.

Definitions

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American: A person having origins in any of the Black racial groups of Africa.

Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

American Indian or Alaska Native: A person having origins in any of the original peoples of North America or South America, including Central America, and who maintains tribal affiliation or community attachment.

Two or More Races: A person who identifies with more than one of the race categories listed above.

Applicant Survey Survey of Protected Veteran Status

This employer is a government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended (Section 4212), which requires government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. Our affirmative action policy prohibits discrimination and requires us to take affirmative action to employ and advance in employment qualified protected veterans at all levels of employment. The below invitation is made pursuant to this policy.

Disclosure of this information is voluntary and refusing to provide it will not subject you to any adverse treatment. The information will be used only in ways that are consistent with Section 4212. The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

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.

Invitation to Self-Identify

Please answer the following questions:

Do you identify as one (or more) of the following protected veteran categories? Categories and definitions below.
Please check the appropriate box below this section. NOTE: You do not have to indicate which specific category applies.

Disabled Veteran: (i) 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 Veteran Affairs; or (ii) a person who was discharged or released from active duty because of a service-connected disability.

Recently Separated Veteran: 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.

Armed Forces Service Medal Veteran: 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 medal was awarded pursuant to Executive Order 12985.

Active Duty Wartime or Campaign Badge Veteran: a veteran who served on active duty in the U.S. military, ground, naval, or air service either during a “period of war” as defined below or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

“Period of war” is defined for these purposes by the Department of Labor as:

• June 27, 1950 to January 31, 1955 (Korean conflict)
• February 28, 1961 to May 7, 1975 (Vietnam service in the Republic of Vietnam)
• August 5, 1964 to May 7, 1975 (Vietnam conflict for all other veterans)
• August 2, 1990 to present (Gulf War)

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us 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 this 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:

• 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

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Please read the following Applicant Statement carefully before signing:

I certify that all information I have provided in order to apply for and secure work with KVK Tech, Inc. is true, complete and correct.

I hereby give KVK Tech, Inc. the right to make a thorough investigation of my past employment, education and activities and I hereby authorize and request any present or former employer, educational institution, law enforcement agency, financial institution, or persons having personal knowledge about me to furnish KVK Tech, Inc., and/or its agents, with any and all information in their possession regarding me in connection with an application for employment. I release from all liability and hold harmless all persons, companies, organizations and entities supplying this information to KVK Tech, Inc. and/or its agents. I further indemnify KVK Tech, Inc. against any liability that might result from making such investigations. A photocopy of this authorization is as effective as the original. I certify under the pains and penalties of perjury that the facts stated herein are true and correct to the best of my knowledge, and that I have not omitted or concealed any relevant information. I understand that any false answers, slanders or implications made by me in this application or any other required documents, regardless of when they are discovered, shall be considered sufficient cause for denial of employment or discharge.

I understand that KVK Tech, Inc. does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I further understand that nothing contained in this Employment Application or in the granting of an interview is intended to create an employment contract between KVK Tech, Inc. and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon KVK Tech, Inc. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and KVK Tech, Inc. retains a similar right. I also recognize this application is conditional upon my presenting to KVK Tech, Inc. proper documents showing that I am eligible to work in the United States, I agree to submit to KVK Tech, Inc. the documents required by law showing work eligibility. I will provide KVK Tech, Inc. with copies of all employment and/or confidentiality agreements between me and any of my former employers that may contain continuing obligations on my part to any such employer.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient case to cancel further consideration of this application or immediately discharge me from KVK Tech, Inc.’ service, whenever it is discovered.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

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