Fields marked with (*) are required.
Various agencies of the United States Government require certain employers to maintain information on applicants pertaining to factors such as race, gender and type of position applied for. The information requested on this sheet is for the purpose of our compliance with these record-keeping requirements and to determine recruiting and employment patterns. When reported, data will not identify any specific individuals. Our company is committed to the employment and advancement of applicants and employees regardless of race, color, sex, religion, national origin, physical or mental disability, veteran status, sexual orientation, age or marital status.
Completion of this form is voluntary and in no way affects the decision regarding your employment opportunity. This form is confidential and will be maintained separate from your employment application form, and will not be used in any manner inconsistent with applicable local, state, or federal legislation.