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Request For EEOC Information
Important-Applicants Please Read: Qualified applicants are considered for employment, and employees are treated during employment without regard to race, color, religion, national origin, citizenship, age, sex, marital status, ancestry, physical or mental disability, veteran status, or sexual orientation.

Solely to help us comply with federal and state Equal Employment Opportunity record keeping, reporting, and other legal requirements, we request that you complete this data information form.

Please note: Completion of this form is voluntary. Refusal to complete this information will not subject any applicant or employee to adverse treatment. This form does not include your name and is completely detached from the employment application. The information you provide will be recorded and maintained in a confidential file, separate from all other records. This information will not be used in consideration for your employment.

Applicant Data Information Form
American Indian or Alaskan Native: A person with origins in any of the original peoples of North America and who maintains cultural identification through tribal affiliation or community recognition.
Asian or Pacific Islander: A person with origins in any of the original peoples of Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Republic, and Samoa.
Black (not of Hispanic origin): A person with origins in any of the black racial groups of Africa who is not of Hispanic origin.
Hispanic: A person of Mexico, Puerto Rican, Cuban, South American, or other Spanish culture or origin, regardless of race.
White (not of Hispanic origin): A person with origins in any of the original peoples of Europe, North Africa, or the Middle East who is not of Hispanic origin.
Special Disabled Veteran: YesNo
A person (a) who is entitled to compensation under laws administered by the Veterans Administration for a disability rated at 30 percent or more, or (b) a person who was discharged or released from active duty because of a service-connected disability.
Disabled Individual: Yes No

A person who (1) has a physical or mental impairment that substantially limits one or more of his or her major life activities, (2) has a record of such impairment, or (3) is regarded as having such an impairment. A disability is "substantially limiting" if it is likely to cause difficulty in securing, retaining, or advancing in employment.

An individual who has a physical or mental impairment that substantially limits one or more of the major life activities, has a record of such an impairment, or is regarded as having an impairment.
Veteran of the Vietnam Era: YesNo
A person who (a) served on active duty for a period of more than 180 days, any part of which occurred between August 5, 1964 and May 7, 1975, and was discharged or released therefrom with other than a dishonorable discharge, or (b) was released from such active duty for a service-connected disability, and a person who was discharged or released within 48 months preceding an alleged violation of the Vietnam Era Veterans' Readjustment Assistance Act of 1974, the affirmation of action clause, or the regulations issued pursuant to the Act.

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