Affirmative Action/eeo Form printable pdf download

Affirmative Action/EEO Form – Applicants for Open Positions (Solicited)

Applicant Information

Full Name:

Last

(please print)

First

M.I.

Zip Code:________

Position Applied for: _______________________

Job Order # __________________

Voluntary Self I.D. Information

Employees are treated equally during the hiring process and employment without regard to race, color,

religion, creed, national origin, age, disability, marital or veteran status or any other legally protected

status.

As an employer with an Affirmative Action Program, we comply with government regulations, including

Affirmative Action responsibilities where they apply.

The purpose for this Data record is to comply with government recordkeeping, reporting, and other legal

requirements. Periodic reports are made to the government on the following information. The completion

of this Data Record is optional. If you choose to volunteer the requested information please note that all

Data records are kept in a confidential file and are not a part of your application for employment or

personnel file. Please note:

YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY

DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.

I understand the reason for this request as stated above and choose to decline filling out this form.

I understand the reason for this request as stated above and have chosen to complete this form.

Gender:

Check the one that applies:

Male

Female

Ethnicity:

Check the one that applies:

Yes, Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or

other Spanish culture or origin, regardless of race.

No, not Hispanic or Latino

Race: Answer this section only if you selected “No, not Hispanic or Latino” above.

Check one or more of the following race categories:

White (not Hispanic/Latino) – A person having origins in any of the original peoples of Europe, the

Middle East, or North Africa.

Black or African American (not Hispanic/Latino) – A Person having origins in any of the Black

racial groups of Africa.

Asian (not Hispanic/Latino) – 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 (not Hispanic/Latino) – A person having origins in any

of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

American Indian or Alaska Native (not Hispanic/Latino) – 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.

Two or More Races (not Hispanic/Latino)

OVER

Affirmative Action/eeo Form

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