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VOLUNTARY SELF-IDENTIFICATION INFORMATION

ELEGED HOME CARE INC is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to sex, race, color, national origin or ancestry, age, handicap, marital status, source of income, class, physical characteristics, sexual orientation or political beliefs.

As an employer, we comply with government regulations and affirmative action responsibilities. Solely to help us comply with government record keeping, reporting and other legal requirements, please complete this Voluntary Self-Identification Information form. This data is for analysis and affirmative action only and submission of this information is voluntary. This data will be kept in a confidential file separate from your Application for Employment.

According to the American with Disabilities Act, the term “disability” means, with respect to an individual, a physical or mental impairment that substantially limits one or more of the major life activities of that individual, a record of such an impairment, or being regarded as having such an impairment.

ADA REQUIREMENTS
The information below is intended to describe the general context/requirements needed to perform this job. During a typical workday, this position requires the activities listed. It is not to be considered as an exhaustive statement of duties, responsibilities, or requirements and does not limit the assignment of additional duties. The frequency of each activity is identified by the following columns:
PHYSICAL ACTIVITIES REQUIRED IN THIS POSITION
Pushing/Pulling
Lifting/Carrying

SENSORY ACTIVITIES

ENVIRONMENTAL CONSIDERATIONS

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