Voluntary Affirmative Action Form

Thank you for your assistance with our EEO reporting requirements.


    Our company asks that all applicants and employees fill out this form, but it is not required to obtain employment and it will not subject the applicant or employee to any adverse treatment. It is necessary to record this information in order to comply with federal, state, and local fair employment practice laws. This information will be kept confidential and maintained separately from your application form.

    It will be used only in accordance with federal requirements. Subject to the Far West, Inc. shareholder hire policy, all qualified applicants and employees will receive consideration for employment opportunities without regard to race, color, religion, national origin, sex, age, physical handicap, veteran or marital status, pregnancy, or parenthood. Inquiries concerning the application of federal, state, and/or local regulations and this requested information may be directed to this office.


    Please check the appropriate spaces:

    Indicate Veteran status, if applicable:

    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

    Please check one of the following:

    Thank you for your assistance with our EEO reporting requirements.

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