We appreciate your interest in our organization and are sincerely interested in your background and qualifications. Please answer all questions as thoroughly as
possible so we may review this information in consideration of employment with our organization. We are an Equal Opportunity Employer and will recruit, hire,
promote and train in all jobs without regard to race, color, religion, age, disability, veteran status or non -job -related felony conviction records.
Equal Employment Opportunity Data Collection Sheet
Completion of this form is optional and will in no way affect your application.
To help us comply with federal/state Equal Employment Epportunity reporting requirements, we ask that applicants complete the following questions. This pre-employment
form is not part of the application for employment and is maintained in a confidential file separate from the application. Data is used for statistical purpose and to measure
effectiveness of recruitment efforts.
Title of Job Applied for:
Date of Application:
RACE:
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 in Africa.
Hispanic - All persons of Mexican, Puerto Rican, Cuban, Central or South America, or other Spanish culture or origin, regardless of race.
Asian or Pacific Islander - All person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands.
Origins include, for example: China, India, Japan, Korea, the Philippine Islands, Samoa, and Hawaii.
American Indian or Alaskan Native - All persons having origins in any of the original indigenous peoples of North America, and who maintain cultural identifi-
cation through tribal affiliation or community recognition.
Please check any and all categories that apply to you:
Questions? Contact us
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