Employee Affirmative Action Voluntary Identification Please enable JavaScript in your browser to complete this form.This Company is a government contractor. A requirement for Federal or Federally Assisted Construction Contrace is to report the number of handicapped, veteran, male/female, and minority/non-minority employees and we have. An Equal Opportunity Employer Submission of the information requested is strictly voluntary Name *FirstLastLayoutPosition Applied For:Referral Source(s):AdvertisementEmployeeRelativeWalk-inOtherGovernment Employment AgencyPrivate Employment AgencyDateWhat is your race/ethnic origin?WhiteBlack or African AmericanHispanic or LatinoAsianNative Hawaiian or Other Pacific IslanderAmerican Indian or Alaska NativeTwo or more racesName of referral source (if applicable)LayoutWhat is your gender?MaleFemaleAre you an individual with a disability?YesNoPlease select all categories that appy to you:Disabled VeteranYesNoA veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service connected duty.Other Protected VeteranYesNoA veteran who served on active duty U.S. military, ground, naval or air service during war or in a campaign or expedition for which a campaign badge has been authorized.Armed Forces Service Medal VeteranYesNoA veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 (61 Fed. Reg.1209)Recently Separated VeteranYesNoA veteran during a three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.This information will be used only for Affirmative Action reporting purposes and will not become part of your employment file or application, nor will it be used as a basis for any personnel action. Submission of this information is confidential, and is solicited on a strictly voluntary basis. Your decision to provide the information will not result in any adverse treatment. I decline to provide this informationYesNoThis company is an Equal Opportunity / Affirmative Action Employer and does not discriminate on the basis of racer color, creed, religion, national origin, ancestry, sex, sexual orientation, disability, age, marital status, pregnancy or childbirth, use of lawful produce, arrest or conviction record, honesty testing, genetic testing or information, military service membership, status with regard to public assistance, local human right commission activity, gender identity, height, weight or other basis prohibited by applicable local, state or federal fair employment laws or regulations. LayoutDate SignatureClear SignatureSubmit