Equal Employment Opportunity Voluntary Information
We consider all applicants for positions without regard to race, color, religion, sex,
national origin, citizenship, age, mental or physical disabilities, veteran/reserve/national
guard or any other similarly protected status. We also comply with all applicable laws
governing employment practices and do not discriminate on the basis of any unlawful
criteria.
In an effort to comply with requirements regarding government record keeping, reporting
and other legal obligations which may apply, we invite you to complete this applicant
data survey. Providing this information is STRICTLY VOLUNTARY. Failure to
provide it will not subject you to any adverse personnel decision or action. Your
cooperation is appreciated.
Please be advised that this survey is NOT a part of your official application for
employment. It will not be used in any hiring decisions. The information will be kept
confidential in accordance with applicable laws and regulations.
Name: ______________________________________________ Date: _____________
Position Applying For:____________________________ Gender:
Male
Female
Ethnic Group (Please Indicate Only One)
(Not of Hispanic Origin) - All person having origins in
White
any of the original people of Europe, North Africa, or
the Middle.
African
(Not of Hispanic Origin) - all persons having origins in
American
any of the Black racial groups of Africa.
All persons of Mexican, Puerto Rican, Cuban, Central or
Hispanic
South American, or other Spanish Culture or origin,
regardless of race.
All persons having origins in any of the original people
Asian or
of the Far East, Southeast Asia, the Indian subcontinent,
Pacific Islander
or the Pacific Islands. This area includes, for example,
China, Japan, Korea, the Philippine Islands and Samoa.
American
All persons having origins in any of the original people
Indian, Native
of North America, and who maintain cultural
American, Alaskan
identification through tribal affiliation or community
Native
recognition.
All persons having parents of different races as
identified by federal agency to include American Indian
Multi-racial
or Alaskan Native, Asian or Pacific Islander, Black,
Hispanic, White.