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HUMAN RESOURCE SERVICES

Applicant Data Request Card

The following information is requested in accordance with Executive Order 11246 and its implementing regulations. It is requested for statistical reporting and to meet federal affirmative action monitoring requirements. It is treated in a highly confidential manner. Provision of the information is strictly voluntary; a decision not to provide the information will not affect consideration of your application. However, we urge your cooperation in this matter and thank you in advance for your assistance.

 

Name:

Date:

Position Applied for:

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Source:
(How did you learn of this opening?) Please be specific, i.e. name of newspaper, website, etc.

Birthdate: Gender:  Male Female

Zip Code: State:

Race/Ethnic Information

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American Indian/Alaska NativeMultiracial Native Hawaiian/Pacific Islander

Other:

 






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