AFFIRMATION ACTION SURVEY AFFIRMATION ACTION SURVEY This data is for periodic government reporting and will be kept in an Affirmative Action file separate from the Application for Employment. Solely to help us comply with government record keeping and other local requirements, please fill out the Applicant Data Record. We appreciate your cooperation. Government agencies require periodic reports on the sex, ethnicity, handicapped, and veteran status of applicants. This data is for analysis and affirmative action only. Submission of information is voluntary. Check One:(Required) Male Female Check (ONLY ONE) of the following: Hispanic or Latino White (Not Hispanic or Latino) Black or African American (Not Hispanic or Latino) Native Hawaiian or other Pacific Islander (Not Hispanic or Latino) Asian (Not Hispanic or Latino) American Indian or Alaskan Native (Not Hispanic or Latino) Two or more races (Not Hispanic or Latino) Check if any of the following are applicable: Veteran Vietnam Era Veteran Disabled Veteran Handicapped Individual Position(s) Applied For: Referral Source: Choose (ONLY ONE) Advertisement Friend Relative Walk-in Employment Agency Other Date Signature CAPTCHA
