EEO Identification

Various agencies of the United States Government require employers to maintain information on applicants pertaining to factors such as race, sex and type of position for which an individual applies. The information requested on this sheet is for compliance with certain record keeping requirements. The Companies believe all persons are entitled to equal employment opportunities and do not discriminate against its employees or applicants for employment because of race, color, sex, religion, national origin, disability, veteran status, age, marital status or any other protected group status.

Name *

First

Last

Date *

Position Applied For *

Social Security Number *

Date of Birth *

Gender *

Race/Ethnic Data *

White (Non Hispanic) Origins of Europe, North Africa, or Middle East
Black or African American (Non Hispanic) Origins in any of the Black racial groups of Africa
Asian (Non Hispanic) Origins of the Far East, Southeast Asia, or the Indian subcontinent
Hispanic or Latino Mexican, Cuban, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race
Native Hawaiian or Other Pacific Islander Origins of Hawaii, Guam, Samoa, or other Pacific Islands
American Indian or Alaskan Native - Origins of North and South America (including Central America), who maintain tribal affiliation or community attachment
Two or more races (Non Hispanic) All persons who identify with more than one of the above races

Regulations issued by the U.S. Department of Labor with respect to disabled individuals, disabled veterans and Vietnam Era veterans require that federal contractors provide an opportunity for self-identification to candidates seeking employment. Such self-identification is submitted on a voluntary basis, on a confidential basis, for use only in accordance with regulations, and without subjecting the individual to adverse treatment.

Disabled/Veteran Classification *

Not a Veteran or Disabled Veteran
Special Disabled Veteran (30% or more disability)
Vietnam Era Veteran
Other Eligible Veteran

Disabled Individual *

Yes
No

COMPANY

NAVIGATION

CONTACT