Equal Employment Opportunity/Affirmative Action Statistics


PLEASE FILL THIS FORM OUT WITH YOUR APPLICATION.

THANK YOU

For Equal Employment Opportunity/Affirmative Action statistical purposes please complete the following items. This information will NOT be maintained with your application and is for statistical purposes only.

DATE:________________________

NAME:________________________

POSITION APPLYING FOR:_______________________________

RACE/NATIONAL ORIGIN:_______________________

SEX:_________________AGE:_____

DISABILITY, IF ANY:________________________________

HOW DID YOU LEARN ABOUT THIS POSITION?________________________________

ARE YOU A VETERAN OF OUR US MILITARY, GROUND, NAVAL, OR AIR SERVICES:             YES or NO

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