In order to maintain records requested by the federal government and to comply with federal affirmative action reporting guidelines for equal opportunity employment prohibiting employment practices which discriminate on the basis of race, color, sex, ethnic group, military veteran status or disability, we request that you indicate on the following checklist:

  1. your sex;
  2. whether you are of Hispanic or Latino ethnicity;
  3. the racial or ethnic group to which you belong

Information on this questionnaire will be confidential and will be kept and stored separately from your application. This information will be maintained and used only in accordance with the federal affirmative action reporting guidelines.

Completion of this form is optional.

Date of application: Please check one category Indicate whether you are of Hispanic or Latino ethnicity

If you have not checked the box above, please check one of the following