Applicant Affirmative Action Information Form printable pdf download

RNL Facilities Corporation

APPLICANT AFFIRMATIVE ACTION INFORMATION

It is the policy of this organization to provide equal employment opportunity to all qualified applicants for

employment without regard to race, color, sexual orientation, gender identity, religion, national origin, sex, age,

veteran status or disability. As an affirmative action employer under E.O. 11246, we invite all applicants to

identify themselves as indicated below.

COMPLETION OF THIS FORM IS VOLUNTARY AND IN NO WAY AFFECTS THE DECISION

REGARDING YOUR APPLICATION FOR EMPLOYMENT. THIS FORM IS CONFIDENTIAL AND

WILL BE MAINTAINED SEPARATELY FROM YOUR APPLICATION FORM.

PLEASE PRINT

Name __________________________________________________ Date_____________

Last

First

Middle

Position applied for (list only one) _________________________________________________________________

Where did you hear about this job? ________________________________________________________________

Race/Ethnicity (You may mark one or more of the following):

White—A person having origins in any of the original peoples of Europe, the Middle East, or North

Africa.

American Indian or Alaska Native—A person having origins in any of the original peoples of North

and South America (including Central America), and who maintains tribal affiliation or community

attachment.

Hispanic or Latino—A person of Cuban, Mexican, Puerto Rican, South or Central American, or other

Spanish culture or origin, regardless of race.

Black or African American—A person having origins in any of the black racial groups of Africa.

Asian—A person having origins in any of the original peoples of the Far East, Southeast Asia, or the

Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan,

the Philippine Islands, Thailand, and Vietnam.

Native Hawaiian or Other Pacific Islander—A person having origins in any of the original peoples of

Hawaii, Guam, Samoa, or other Pacific Islands.

Sex:

Male

Female

I elect not to identify

Signature _________________________________________________________________________

Applicant Affirmative Action Information Form