Why are you interested in working at Harlem Village Academies?*
How did you hear about this job?*
If you have been previously employed by HVA, please provide position, location, and dates of employment.*
Please indicate if you are a member or alum of one of these programs:*
Teach for America
NYC Teaching Fellows
Math For America
Provide three professional references. We will not contact any of these references without notifying you ahead of time. Provide: Name, Title, Organization, Email, Phone, Years Acquainted.*
Will you now or in the future require sponsorship for an immigration-related employment benefit?
Will you now or in the future require sponsorship for an employment visa? If you have a visa, how much time remains on your current visa?
U.S. Equal Opportunity Employment Information (Completion is voluntary)
Individuals seeking employment at this company are considered without regards to race, color, religion, national
origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation. You are being
given the opportunity to provide the following information in order to help us comply with federal and state Equal Employment
Opportunity/Affirmative Action record keeping, reporting, and other legal requirements.
Completion of the form is entirely
voluntary. Whatever your decision, it will not be considered in the hiring
process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.
Decline To Self Identify
American Indian or Alaskan Native
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
Two or More Races
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If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.
As a government contractor subject to Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure
the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories
is 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.
I am not a protected veteran
I identify as one or more of the classifications of a protected veteran
I don't wish to answer
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
1. 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?
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Disabilities include, but are not limited to:
Multiple sclerosis (MS)
Missing limbs or partially missing limbs
Post-traumatic stress disorder (PTSD)
Obsessive compulsive disorder
Impairments requiring the use of a wheelchair
Intellectual disability (previously called mental retardation)
Yes, I have a disability (or previously had a disability)
No, I don't have a disability
I don't wish to answer