Applicant'S Demographic Information Template
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4DEMOGRAPHIC INFORMATION ON APPLICANTS
OMB No.: 3046-0046
Expiration Date: 02/28/2017
Vacancy Announcement No.:
Position Title:
YOUR PRIVACY IS PROTECTED
This information is used to determine if our equal employment opportunity efforts are reaching all segments of the population,
consistent with Federal equal employment opportunity laws. Responses to these questions are voluntary. Your responses
will not be shown to the panel rating the applications, to the official selecting an applicant for a position, or to anyone else who
can affect your application. This form will not be placed in your Personnel file nor will it be provided to your supervisors in
your employing office should you be hired. The aggregate information collected through this form will be kept private to the
extent permitted by law. See the Privacy Act Statement below for more information.
Completion of this form is voluntary. No individual personnel selections are made based on this information. There will be no
impact on your application if you choose not to answer any of these questions.
Thank you for helping us to provide better service.
1. How did you learn about this position? (Check One):
□
Agency Internet Site recruitment
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Private Employment Web Site
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Other Internet Site
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Job Fair
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Newspaper or magazine
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Agency or other Federal government on campus
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School or college counselor or other official
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Friend or relative working for this agency
.
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Private Employment Office
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Agency Human Resources Department (bulletin board or other announcement)
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Federal, State, or Local Job Information Center
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Other
2. Sex (Check One):
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Male
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Female
3. Ethnicity (Check One):
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Hispanic or Latino - a person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin, regardless of race.
□
Not Hispanic or Latino
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