Fill and Sign the Affirmative Action Information Form

AFFIRMATIVE ACTION INFORMATION FORM You are not required to provide this information. We are an affirmative action government contractor. In compliance with government regulations we are required to track the number of our applicants by gender, race/ethnicity, and the positions for which they have applied. We invite you to indicate your gender and race/ethnicity below. We will keep this information separate from your application and will use it only in accordance with federal and state regulations. Your application for employment will be considered in the same manner whether or not you fill out this form. Gender: Male Female Date of birth _________ Race/Ethnic Group: White (Not of Hispanic origin)…All persons having origins in any of the original peoples of Europe, North Africa, or Middle East. Black (Not of Hispanic origin)...All persons having origins in any of the black racial groups of Africa. Hispanic...All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. Asian...All persons having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent. This area includes, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. American Indian or Alaskan Native...All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition. Native Hawaiian or other Pacific Islander...All persons having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Island. Other (Please Specify):       Name:       Date of application:       Position applied for:       Referred by:       How did you learn about the position?