APPLICANT DATA RECORD

Qualified applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, or disability.

As an employer and government contractor, we comply with government regulations and affirmative action responsibilities.

Solely to help us comply with government record keeping, reporting and other legal requirements, please fill out the Data Record.

This Data is for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment. Your cooperation is voluntary.

AFFIRMATIVE ACTION SURVEY

Government agencies requires periodic reports on the sex, ethnicity, disability and veteran status of applicants. This data is for analysis and affirmative action only. Submission of information about a disability is voluntary.
Check one:
Check one of the following:
Race/Ethnic Group:
Check if any of the following are applicable:
 

EMPLOYMENT SOURCE

Position(s) Applied for:
Referral Source:
Identify Specific Source: