VOLUNTARY AFFIRMATIVE ACTION INFORMATION FORM - APPLICANTS
(Confidential: For Statistical Use Only)

In an effort to implement out voluntary government affirmative action program record keeping and reporting requirements, we ask that you complete this data survey. Your cooperation is appreciated. Providing this information is STRICTLY VOLUNTARY. Failure to provide it will not subject you to any negative personnel action. Information provided is kept confidential in accordance with applicable regulations.

POSITION 

Referral Source:

Internet
Employee Referral
Website
Recruiter
Newspaper
Organization
Job Fair
Other
Walk-In

Comments:

Gender:

Male
Female
Decline to identify

Race / Ethnicity (Please check one box only):

Hispanic or Latino ~ A person of Cuban, Mexican, Puerto Rican, Central or South American or other Spanish culture or origin, regardless of race

White (Not Hispanic or Latino) ~ A person having origins in any of the original peoples of Europe, North Africa or Middle East

Black or African-American (Not Hispanic or Latino) ~ A person having origins in any of the Black racial groups of Africa.

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) ~ A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Asian (Not Hispanic or Latino) ~ A person having origins in any of the original peoples of the Far East, Southeast Asia , the Indian Subcontinent for example, Cambodia, China , India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

American Indian or Alaskan Native (Not Hispanic or Latino)~ A person having origins in any of the original peoples of North America and South America (including Central America), and who maintain a tribal affiliation or community attachment.

Two or More Races (Not Hispanic or Latino) ~ All persons who identify with more than one of the races of: White, Black or African American, Native Hawaiian or Other Pacific Islander, Asian, or American Indian or Alaska Native.

Decline to identify

Date: -- mm/dd/yy   

Type Your Full Name Here to Authorize