Application For Employment - City Of Fairfield Page 3

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Recruitment Survey
(For Statistical Purposes Only)
The City of Fairfield is interested in monitoring the demographics of applicants as well as employees in order to acquire data for
EEOC and OH Civil Rights reporting. Please assist us by filling out and returning this form. You may return this form with your
application or separately to the City of Fairfield, Human Resources, 5350 Pleasant Avenue, Fairfield, OH 45014.
Completion of
this form is voluntary and your failure to provide this information will have no effect on your employment prospects with the
City of Fairfield.
POSITION APPLIED FOR:
_______________________________________________________________________________
SEX:
___________ MALE
____________ FEMALE
AGE:
________
ETHNIC ORIGIN:
________African American
________American Indian or Alaskan
________Asian or Pacific Islander
________Hispanic
________White
________Other_________________________________________________________________________
How did you find out about this job opening?
________Cincinnati Enquirer
________Hamilton Journal-News
________Middletown Journal-News
________Cincinnati Herald
________The Center for Local Government
________City of Fairfield Web-site
________Channel 17
________City Employee
________ Other

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