Internal Job Application for Job Opportunities

Applicant Self-Identification Form

Providing this information is strictly voluntary on your part, and is not required to complete your Application for Employment. Nor, will providing the information or not providing the information affect your application.

Federal government regulations require (organization name) to maintain records of job applicants by gender and race. Additionally, we collect this information to ensure that we are monitoring our own success in encouraging diverse applicants.

Please assist us by providing the requested information. Providing this information is strictly voluntary on your part, and is not required to complete your Application for Employment.

Female_______ Male_______

1. _______African-American/Black (not of Hispanic origin)

2. _______Asian or Pacific Islander (includes Indian Subcontinent)

3. _______American Indian or Alaskan Native

4. _______Hispanic/Latino (Spanish culture or origin, regardless of race)

5. _______White (persons not of Hispanic origin, having origins in any of the original peoples of Europe, North Africa, or the Middle East)

6. Race not included above

Please specify_______________________________________

Are you multi-racial or multi-ethnic (parents from two or more of the above listed groups)?

Yes______ No______

If yes, please specify ________________________________________________________

Thank you for your assistance.

Internal Job Application Procedure Instructions

Internal Job Application Form

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