Applicant Information Form
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1
2Applicant Information Form
The Legal Aid Society is an equal opportunity employer and is committed to the principle of workforce diversity,
which ensures that the full range of interests and experiences of our client population are reflected in and
understood by members of our workforce. Diversity includes actual or perceived age, race, color, creed, religion,
disability, marital status, pregnancy, national origin and citizenship, gender, gender identity or expression, sex,
sexual orientation, and veteran status. Applicants for employment are invited to report their status as a diversity
candidate. In extending this invitation, please be advised that you are under no obligation to report diversity status.
Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment.
Responses will remain confidential within the Recruitment and Human Resources Departments. Responses will be
considered in scheduling applicants for interviews but will not be determinative in the selection process. Responses
may also be used for statistical purposes. When reported, data will not identify any specific individual.
Please complete the information requested below. Thank you for your cooperation.
Section 1: General Applicant Information
Name
Date
For which position are you applying?
For which Practice Area(s) are you applying (check all that apply)?
Criminal
Juvenile Rights
Civil
Section 2: Voluntary Self-Identification. Please check all that apply.
Race or Ethnic Identity
Gender ID and Sexual Orientation Veteran Status
American Indian or Alaskan Native (not
Gender ID
Recently Separated Veteran
Hispanic or Latino)
Female
Disabled Veteran
Asian (not Hispanic or Latino)
Gender Non-Conforming
Other Protected Veteran
Black or African American (not Hispanic or
Male
Armed Forces Service Medal
Latino)
Veteran
Transgender female
Hispanic or Latino
Disability Status
Transgender male
Native Hawaiian or Other Pacific Islander
(not Hispanic or Latino)
Individual with Disabilities
Self Identified/Other (specify)
_________________
Two or More Races (not Hispanic or
I am requesting a reasonable
Latino)
accommodation:
I do not wish to self-identify
White (not Hispanic or Latino)
_______________________________
Sexual orientation
I do not wish to self-identify
_______________________________
Bisexual
_______________________________
Gay
Heterosexual
Other Protected Status (specify)
Lesbian
(see definitions attached)
Self Identified/Other (specify):
_______________________________
________________
I do not wish to self-identify
How did you hear of our opening?
Current Employee
Job fair / On Campus
Newspaper Ad
Recruiter
Prior Internship
Online (specify site): ________________________
Other - (explain): _____________________________________
Signature:
_______________________________________________________________________
For Human Resources Use Only:
Job Posting #:
Practice Area:
Revised June 12, 2014
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