Nikon Careers

Page 1

EEO VOLUNTARY SELF-IDENTIFICATION FORM


We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status or any other classification protected by federal, state or local law. The information below will be kept confidential and will 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 affirmative action compliance. Completion of this data is voluntary and will not affect your opportunity for employment or terms or conditions of employment, if hired.

If you are a resident of California or any other U.S. state that has enacted data privacy legislation that pertains to personal information (collectively, “Privacy Laws”), this is notice that such Privacy Laws may be applicable to the personal information you submit to Nikon for recruiting and employment application purposes, and Nikon will use such personal information for the business purpose of recruitment and employment activities including but not limited to processing your application, conducting interviews and background checks and contacting you regarding any of the foregoing. For more information regarding Nikon’s collection and use of personal information and your rights with respect thereto, please review Nikon’s applicable Privacy Policy. Nikon Inc.’s Privacy Policy is available at www.nikonusa.com. Nikon Instruments Inc.’s Privacy Policy is available at https://www.microscope.healthcare.nikon.com/. Nikon Americas Inc.’s Privacy Policy is available at nikonusa.com/content/privacy-policy.
Please fill out the information below:






Page 2

EEO VOLUNTARY SELF-IDENTIFICATION FORM


We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status or any other classification protected by federal, state or local law. The information below will be kept confidential and will 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 affirmative action compliance. Completion of this data is voluntary and will not affect your opportunity for employment or terms or conditions of employment, if hired.


Form CC-305
OMB Control Number 1250-0005
Expires 04/30/2026

 

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?


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

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.

 


*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 www.dol.gov/ofccp.


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 check one of the boxes below: