Application: Environmental Services Associate, Full-Time 1st Shift, Weekend; On-Call Job at Rochelle Community Hospital in Rochelle, IL

Thank you for your interest in Rochelle Community Hospital’s job opening. Individuals seeking employment at Rochelle Community Hospital are considered without regards to race, color, religion, gender identity, national origin, sexual orientation, age, marital status, medical condition, physical or mental disability, protected veteran status, or any other legally protected status. And because we do business with the government, our recruiting and hiring practices must meet affirmative action and equal employment opportunity standards. Part of this is inviting applicants to self-identify which allows us to comply with federal and state Equal Employment Opportunity/Affirmative Action record keeping, reporting, and other legal requirements. Completing this survey is voluntary, but we hope that you will choose to answer. All responses are kept private and will not be used against you in any way. Thank you, Careers@rcha.net

Q1. How did you hear about this position?

Our company is an Equal Opportunity Employer/Disabled/VETS/Affirmative Action Employer. Applicants can learn more about the company's status as an equal opportunity employer by viewing the federal "EEO is the Law" poster at EEOPost.pdf, its "Supplement" poster at EEO_Supplement.pdf, and its Pay Transparency Nondiscrimination Provision at PayTransparencyNotice.pdf

Q2. This employer is a Government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), 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

These classifications are defined as follows:

A ‘‘disabled veteran’’ is one of the following: 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 a person who was discharged or released from active duty because of a service-connected disability.

A ‘‘recently separated veteran’’ means 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.

An ‘‘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.

An ‘‘Armed forces service medal veteran’’ means 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 service medal was awarded pursuant to Executive Order 12985.

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.

If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. 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.

I identify as one or more of the classifications of protected veteran listed above
I am not a protected veteran
I don't wish to answer

Q3. Voluntary Self-Identification of Disability
Form CC-305
OMB Control Number 1250-0005
Expires 04/30/2026

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 check one of the boxes below:

Yes, I have a disability, or have had one in the past
No, I do not have a disability and have not had one in the past
I do not want to answer

Q4. Voluntary Self-identification Survey – Ethnicity/Race (Part 1 of 2)

This company is an Equal Opportunity Employer/Disabled/VETS/Affirmative Action Employer. This survey is meant to help the company fulfill objectives in its affirmative action plans.

Please note that you are not required to complete this survey. Provision of this information is voluntary. The decision not to complete this survey will not affect any opportunity for employment or any benefits with the company. Any information you provide in this survey will be kept confidential and will not be used in any way that may adversely affect your employment with this company.

ETHNICITY (Please select the appropriate box)

Hispanic (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)
Not Hispanic
Decline to Answer

Q5. Voluntary Self-identification Survey – Ethnicity/Race (Part 2 of 2)

This company is an Equal Opportunity Employer/Disabled/VETS/Affirmative Action Employer. This survey is meant to help the company fulfill objectives in its affirmative action plans.

Please note that you are not required to complete this survey. Provision of this information is voluntary. The decision not to complete this survey will not affect any opportunity for employment or any benefits with the company. Any information you provide in this survey will be kept confidential and will not be used in any way that may adversely affect your employment with this company.

RACE (If you checked "Not Hispanic" in Part 1 above, please check one or more of the boxes below.)

White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.)
Black/African American (A person having origins in any of the Black racial groups of Africa.)
Native Hawaiian or Other Pacific Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)
Asian/Indian Subcontinent (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.)

Q6. Voluntary Self-identification Survey – Gender

This company is an Equal Opportunity Employer/Disabled/VETS/Affirmative Action Employer. This survey is meant to help the company fulfill objectives in its affirmative action plans.

Please note that you are not required to complete this survey. Provision of this information is voluntary. The decision not to complete this survey will not affect any opportunity for employment or any benefits with the company. Any information you provide in this survey will be kept confidential and will not be used in any way that may adversely affect your employment with this company.

GENDER (Please select the appropriate box)

Male
Female
Decline to Answer