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 Electronic Employment Application Form

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Equal Employment Opportunity/ Affirmative Action
Pre-Offer Voluntary Self-Identification Information
Gemini Technologies, Inc. is an EEO/Affirmative Action Employer
As a federal contractor, we
are required to compile the following information in order to comply with federal Equal
Employment Opportunity and Affirmative Action requirements. The information you provide is
strictly on a voluntary basis and failure to supply it will not in any way affect your employment.
To be completed by applicant on a voluntary basis. Not for interview purposes. To be filed separately from application.
If you believe you belong to any of the categories of protected veterans listed below, please
indicate by checking the appropriate box. As a Government contractor subject to VEVRAA, we
request this information in order to measure the effectiveness of the outreach and positive
recruitment efforts we undertake pursuant to VEVRAA.

Hispanic or Latino includes a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture origin, regardless of race.White (not Hispanic or Latino) includes a person having origins in any of the original peoples of Europe, North Africa, or the Middle East, or North America.Black or African American (not Hispanic or Latino) includes a person having origins in any of the Black racial groups of Africa.Native Hawaiian or Other Pacific Islander (not Hispanic or Latino) includes a person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Asian (not Hispanic or Latino) includes a person have 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. American Indian or Alaskan Native (not Hispanic or Latino) includes a person having origins in anyof the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment. Two or More Races (not Hispanic or Latino) includes a person who identifies with more than one of the above races.

A disabled veteran includes any veteran of the U.S. military, ground, naval or air service who: (a) 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 (b) was discharged or released from active duty because of service-connected disability. Active Duty Wartime or Campaign Badge Veteran includes any veteran who served on active duty in the U.S. military, ground, naval or air service in a war, campaign or expedition in which a campaign badge has been authorized under the laws administered by the Department of Defense. Recently Separated Veteran includes 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 includes any veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United State military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Voluntary Self-Identification of Disability

Form CC-305 OMB Control Number 1250-0005 Expires 1/31/2020
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 disabilitiesi .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:
• Blindness
• Deafness
• Cancer
• Diabetes
• Epilepsy
• Autism
• Cerebral palsy
• 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
• Intellectual disability (previously called mental retardation)

Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at
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.

I certify all of the information and the resume I have provided are complete and accurate. I acknowledge falsification, misrepresentation, or omission on this, or any other pre-employment record, may be grounds to refuse employment, or may lead to disciplinary action, up to and including termination of employment, if I am hired. If I am hired, all data provided becomes part of my permanent employment record.
It is the policy of Gemini Technologies, Inc. to provide an environment for each job applicant and employee that is free from sexual harassment, as well as harassment and intimidation on account of an individual’s race, color, religion, creed, sex, affectional or sexual orientation, nation origin, nationality, citizenship, ancestry, marital status, atypical hereditary cellular or blood trait, age, handicap, disability, liability for service in the
Armed Forces of the U.S., and/or U.S. veteran status.
Regardless of whether or not I become employed by Gemini, I recognize and agree that this application is not and should not be considered as a contract of employment. I understand that my employment at Gemini is ‘‘at-will’’. This means that either the company or I can terminate my employment for any reason, with or without cause, and with or without notice, at any time. I further understand that no Gemini employee or representative has the authority to enter into a contract regarding duration or terms and conditions of Gemini employment other than an officer of Gemini and then only by means of a signed written document.