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VOLUNTARY SELF-IDENTIFICATION
(Confidential - for statistical use only)
We are an equal opportunity employer and
do not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status,
sexual orientation or any other classification protected by federal, state or local law.
The information below will be used only in the compilation of data for affirmative action reporting.
Completion of this data is voluntary and will not affect your opportunity for employment or terms or conditions of employment, if hired.
Identification can be declared at any time prior to or, if applicable, after hire. Please return this page with your application.
(* Required data)
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| Social Security #: |
(999-99-9999)
* Invalid
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| Date of Birth: |
(mm/dd/yyyy)
* Invalid
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| * Sex: |
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* Race/Ethnicity:
(Please check one of the descriptions below corresponding to the ethnic group with which you most identify.)
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* Veteran Status:
(Please check one if it describes your veteran status. Veteran status may only be requested after a job offer is made.)
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