The State Of Texas Application For Employment Page 5
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5For State Agency Use Only:
Applicant Number: ________________
APPLICANT EEO DATA FORM
The information requested is optional and is being collected for the purpose of reporting to Federal and Equal Employment
Opportunity Agencies and will not be considered as part of the application for employment. It will be separated from the application.
1. Job Posting Number
2. Last Name
First
Middle
(Type or Print)
3. Address
City
State
ZIP Code
4. Daytime Phone
5. Work Phone
(
)
(
)
6. Sex
7. Birth Date
8. Ethnic Origin
M-Male
Asian/Pac.
Am. Ind/
F- Female
W-White
B-Black
H-Hispanic
P-Islander
I-Alaskan
O-Other
9. Veteran
10. Surviving Spouse of Veteran
11. Orphan of Veteran
12. Former Texas Foster Youth
who has not remarried
25 yrs of age or younger
Yes
Yes
Yes
Yes
No
No
No
No
13. How did you first find out about this job?
06 – Newspaper
01 - Other State Employee
11 -
Name of Newspaper
02 - Job Fair
12 - Other (specify):
07 - College/University Career Day
03 - Professional Publication
08 - Human Resource/Personnel Office
04 - Recruitment Poster
09 – Radio
05 - Television
10 - Agency Web Site - Internet
X
Signature – Applicant
Date
White (Not of Hispanic origin) – All persons having origins in any of the original peoples of Europe, North Africa, or the Middle
East.
Black (Not of Hispanic origin) – All persons having origins in any of the Black racial groups of Africa.
Hispanic – All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless
of race.
Asian or Pacific Islander – All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian
Subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands, and
Samoa.
American Indian or Alaskan Native – All persons having origins in any of the original peoples of North America, and who maintain
cultural identification through tribal affiliation or community recognition.
AN EQUAL OPPORTUNITY EMPLOYER
(0909)
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