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Applicant Data Record

As employers/government contractors, we comply with government and affirmative action responsibilities. To help us comply with government record keeping, reporting and other legal requirements, we would appreciate your cooperation in completing the Applicant Data Record. This data is for periodic government reporting only and will be kept CONFIDENTIAL. This Data Record will be kept separate and will not be considered part of your Application for Employment.

Referal Source
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Affirmative Action Survey

Government agencies require periodic reports on the sex, ethnic background, disability status and veteran status of applicants for employment. This data is for analysis and affirmative action only. Submission of information about disability is voluntary.
Check all that apply: