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Applicant's Statement
In signing this application, I certify that all of the foregoing information is a complete and accurate statement of the facts and understand that if any misrepresentation, omission or falsification be discovered, it will constitute grounds for dismissal. I hereby authorize you to conduct any investigation necessary concerning any part of my background related to the position I am seeking. I release all parties from any liability in connection with the provision and use of such information.
I understand and agree that, if employed by the organization, I will abide by its rules and regulations which I understand are subject to change. I further understand that, if hired, my employment is not for a definite period of time and may be terminated by either party at any time.

Voluntary Equal Opportunity Questionnaire

Gemini Industries Inc. is an Equal Opportunity Employer. Gemini does not discriminate on the basis of race, religion, color, sex, age, non-disqualifying physical or mental disability, national origin, genetic information, or any other basis covered by appropriate law. All employment is decided on the basis of qualifications, merit, and business need.
Gemini is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, Gemini invites applicants to voluntarily self-identify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.
Pertinent portions of Gemini Industries Inc.’s Affirmative Action Plan are available during regular business hours for inspection by employees and applicants for employment.
It is the policy of the company to take affirmative action to seek to employ and advance in employment qualified individuals with disabilities, disabled veterans, veterans of the Vietnam era, armed forces service medal veterans, recently separated veterans, and other protected veterans.
If you have a disability or are a veteran of the Vietnam era, a disabled veteran, armed forces service medal veteran, a recently separated veteran, or other protected veteran; we would like to include you under our affirmative action program. If you would like to be included under the affirmative action program, please tell us.  You may inform us of your desire to benefit under the program at this time and/or at any time in the future.  Submission of this information is VOLUNTARY and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended and with section 503 of the Rehabilitation Act.
Please check EACH of the following that applies to you:
If you are an individual with a disability or a disabled veteran, it would assist us if you tell us about (i) any special methods, skills, and procedures which qualify you for positions that you might not otherwise be able to do because of your disability so that you will be considered for any positions of that kind, and (ii) the accommodations which we could make which would enable you to perform the job properly and safely, including special equipment, changes in the physical layout of the job, elimination of certain duties relating to the job, provision of personal assistance services or other accommodations. This information will assist us in placing you in an appropriate position and in making accommodations for your disability.
The term "disability" means, with respect to the Americans with Disabilities Act refers to an individual who has:
(A) a physical or mental impairment that substantially limits one or more of the major life activities of such individual;
(B) a record of such an impairment; or
(C) being regarded as having such an impairment.
Protected Veteran means a veteran who is protected under the nondiscrimination and affirmative action provisions of the Vietnam Veterans’ Readjustment Assistance Act, 38 U.S.C. 4212; specifically a veteran who may be classified as an active duty wartime or campaign badge veteran, disabled veteran, Armed Forces service medal veteran, or recently separated veteran
Active Duty Wartime or Campaign Badge Veteran means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
Armed Forces Service Medal Veteran means any 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 service medal was awarded pursuant to Executive Order 12985 (61 FR 1209, 3 CFR, 1996 Comp., p.159).
Disabled Veteran means (1) 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 Veterans Affairs, or (2) A person who was discharged or released from active duty because of a service-connected disability.
Recently Separated Veteran means a 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.

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