Application For Employment Form Page 4
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4Oakridge Homes, SILS, Inc
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Applicant Survey Form
_______________________________________________________________________________
Last Name
First Name
Middle Initial(s)
_______________________________________________________________________________
Date
position(s) for which you are applying
Please read carefully:
As an affirmative action employer, we must monitor our equal employment opportunity and affirmative
action program, and report the results to the government agencies. Please help us gather this information
by identifying your sex, race or ethnicity,
disability and veteran status on this form.
Providing this information is completely voluntary. If you choose not to provide some or all of this
information, you will not be subject to any negative or adverse treatment.
The information you provide will be used only to monitor our compliance with equal opportunity laws and
regulations and for no other purpose. * When we receive this form, we will immediately place it in a
confidential file separate from your application. If you wish, you may mail this form to us in an envelope
separate from the one that contains your application.
Race/Ethnicity – Select one or more
American Indian or Alaska na
A person having origins in any of the original peoples of North and South
America (including Central America), and who maintain tribal affilia on or communit
achment.
Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian
subcon nent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.
Black or African American: A person having origins in any of the black racial groups of Africa.
Hispanic or La no: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish
culture or origin, regardless of race.
Na
Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam,
Samoa, or other Pacific islands.
White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Disability – Are you a person with a disability?
Yes
No
Sex – Select one
Female
Male
Veteran
Yes
No
This form is not used for employment decisions. If you have a disability and need an accommodation
so that you can perform the duties of the job for which you are applying, please notify us in some other
manner.
Print Application
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