Voluntary Affirmative Action

All applicants are treated equally without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, 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 record keeping, 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.

Your cooperation is voluntary. Inclusion or exclusion of any data will not affect any employment decision.

* Required Fields

Personal Information

Name is required.

* Name:

Position Applying for is required.

* Position Applying for:

Location of Position is required.

* Location of Position:

Referral Source is required.

* Referral Source:

-select one-
Newspaper / Internet
Employee Referral
WorkSource
Other

Gender:

Male

Female

Race:

Black: 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, regardless of race.

Asian: 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, Japan, Korea, the Philippine Islands, and Samoa.

Native American: All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition. (Meets Bureau of Indian Affairs definition standards).

White (Or Not Covered Above)

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