Applicant EEO Data Form

Please be advised the the requested information is completely voluntary and will not be included with your application documents.

Select Department:  

Select Position:        

 

Name                                                                                                      

First:    Middle Initial:  

Last:  

Address                                                                                                  

Street:  

City:   

State/Country:  

ZipCode: 

Sex                                                                                                         

                     

Are you a U.S. Citizen                                                                           

       

Note that all new employees must be able to provide proof of eligibility to work in the United States; it is the responsibility of the new employee to secure that documentation.

Race/Ethnicity                                                                                       

Mexican, Puerto Rican, Cuban, Central/South American
or other Spanish culture or origin, regardless of race
Origins in any of the original peoples of Europe, North
Africa or the Middle East
Origins in any of the Black racial groups of Africa
Origins in any of the original peoples of Hawaii, Guam,
Samoa, or other Pacific Islands
Origins in any of the original peoples of the Far East,
Southeast Asia, Indian subcontinent of the Pacific Islands;
e.g., China, Japan, Korea, Philippine Islands
Origins in any of the original indigenous peoples of
North or South America and maintains cultural
identification through tribal affiliation/recognition
 

Are you a Veteran of the Armed Services?                                                     

    (If yes, please indicate applicable status)

                    

                   

                   

                   





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