Applicant Data

APPLICANT DATA
The information requested on this form will not be used in any way in making employment decisions or otherwise affect your status as an employee. This information will only be used to determine if our recruitment efforts are reaching all segments of the community and to meet federal Equal Employment Opportunity reporting requirements. Completing this form is voluntary.
Last Name
/ First Name
/ Middle Initial
Date of Birth / Month / Date / Year / Female / Male
Ethnic Origin / Race
Hispanic
or
Latino / Non-Hispanic or
Non-Latino / American Indian/ Alaskan Native / Native Hawaiian or other Pacific Islander
Asian / Black / White
How did you hear about the position for which you were hired?
Media / Job Posting / Other
Local Paper
Which one? ______
Radio
Which station? / College
Which one? / Walk-in
Television
Which station? / Referral source
Which one? / Job Fair:
Web site
Which one? / Job Service / Other:
Other: / Other: