Chief of Party – Orora Wihaze Activity Rwanda

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Employment Application

  • If other, please explain.
  • Are you at least 18 years of age?
  • Are you legally eligible for Employment in the U.S.?
  • Are you the citizen of another country?
  • If yes, please list.
  • Can you perform the essential functions of this job with or without reasonable accommodation?
  • Have you ever worked for CNFA before?
  • If yes, please give date(s) and reason for leaving.
  • Is anyone related to you currently employed by CNFA?
  • If yes, please provide their name(s) and relationship to you.
  • Have you ever been fired or asked to resign from a job?
  • If yes, please explain.
  • What salary or rate of pay do you expect to receive if employed?

Salary Expectations

  • If selected, please indicate your expected annual salary in $ USD.

PLEASE READ CAREFULLY BEFORE SIGNING/INITIALING: I hereby certify that all of the information provided by me in this application (and/or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in the submitted documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery. I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by CNFA that such employment is at will and may be terminated by either CNFA or me at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of CNFA or its representatives used during the employment process is deemed a contract of employment real or implied. I understand that no representative of CNFA except Human Resources has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by Human Resources. In consideration for employment with CNFA, if employed, I agree to conform to the rules, regulations, policies and procedures at all times and understand that such continued obedience is a condition of employment. I further understand that, attendance and punctuality are considered essential requirements of every job at CNFA and that poor attendance or tardiness will result in disciplinary action, up to and including termination. I understand that if offered a position with CNFA, I may be required to submit to a pre-employment medical examination, drug screening and background check as a condition of employment. I further understand that an unsatisfactory result from, refusal to cooperate with, or any attempt to affect the results of these pre-employments tests and checks will result in withdrawal of any employment offer or immediate termination of employment if already employed. I hereby authorize any and all schools, current/former employers, references, courts and any others who have information about me to provide such information to CNFA and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information.

  • I acknowledge that I have read, understood and agree to the above statements.
  • Please initial here

Additional information


U.S. Equal Employment Opportunity information   (Completion is voluntary and will not subject you to adverse treatment)

CNFA provides equal employment and affirmative action opportunities to applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability.

CNFA is a federal contractor or subcontractor subject to certain governmental recordkeeping and reporting requirements for the administration of civil right laws and regulations. Employment decisions are made on the basis of job-related criteria without regard to race, ethnicity, color, religion, sex, sexual orientation, gender identity, marital status, age, genetic information, national origin, disability, military, or veteran status, or any other classification protected by applicable law.

We invite all applicants to voluntarily self-identify their race, ethnicity, and gender. Submission of the information on this form is strictly voluntary and refusal to provide it will not subject you to any adverse treatment. Information obtained will be retained in a confidential file and separate from personnel records. This information may only be used in accordance with the provision of applicable federal laws, executive orders, and regulations. If you want more information about any of the sections, please check with a company representative.


Self-identification of veteran status   (Completion is voluntary and will not subject you to adverse treatment)

CNFA is a Government contractor subject to the Section 4212 of the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, which requires Government contractors to take affirmative action to employ and advance in employment: (1) Disabled veterans – A veteran who served on active duty in the U.S. military and is entitled to disability compensation (or who but for the receipt of military retired pay would be entitled to disability compensation) under laws administered by the Secretary of Veterans Affairs, or was discharged or released from active duty because of a service-connected disability; (2) Recently separated veteran – A veteran separated during the three-year period beginning on the date of the veteran's discharge or release from active duty in the U.S military, ground, naval, or air service; (3) Active duty wartime or campaign badge veteran – A veteran who served on active duty in the U.S. military during a war, or in a campaign or expedition for which a campaign badge was authorized under the laws administered by the Department of Defense; (4) Armed forces service medal veteran – 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 (61 Fed. Reg. 1209). If you believe that you belong to any of the categories of protected veterans, please indicate by making the appropriate selection.


Self-identification of disability   (Completion is voluntary and will not subject you to adverse treatment)

Form CC-305 / OMB Control Number 1250-0005 / Expires 1/31/2020

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?

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:

  • Blindness
  • Deafness
  • Cancer
  • Diabetes
  • Epilepsy
  • Autism
  • Cerebral palsy
  • HIV/AIDS
  • Schizophrenia
  • Muscular dystrophy
  • Bipolar disorder
  • Major depression
  • 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)
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.

Note: Name and date are only required if you filled out Disability status.