MIS Department

Human Resources




Equal Employment Opportunity Voluntary Information

We consider all applicants for positions without regard to race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve/national guard or any other similarly protected status. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria.

In an effort to comply with requirements regarding government record keeping, reporting and other legal obligations which may apply, we invite you to complete this applicant data survey. Providing this information is STRICTLY VOLUNTARY. Failure to provide it will not be subject you to any adverse personnel decision or action. Your cooperation is appreciated.

Please be advised that this survey is NOT a part of your official application for employment. It will not be used in any hiring decisions. The information will be used and kept confidential in accordance with applicable laws and regulations.


Position Applying For: Date: Sex:MaleFemale


Ethnic Group (Please Indicate Only One)

White (Not of Hispanic Origin) - All person having origins in any of the original people of Europe, North Africa, or the Middle.
Black or African American (Not of Hispanic Origin) - all persons having origins in any of the Black racial groups of Africa.
Hispanic All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish Culture or origin, regardless of race.
Asian or Pacific Islander All persons having origins in any of the original people of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands and Samoa.
American Indian, Native American, Alaskan Native All persons having origins in any of the original people of North America, and who maintain cultural identification through tribal affiliation or community recognition.
Multi-Racial All persons having parents of different races as identified by federal agency to include American Indian or Alaskan Native, Asian or Pacific Islander, Black, Hispanic, White.


Thank you for your assistance!

CSHS

Copyright 2005, Cherry Street MIS Department