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Equal Employment Opportunity Form Application Information YOUR LOGO HERE Full Name:
Home Phone: ( ) Social Security Number:
Position Applied for: Voluntary Information This information is being requested in accordance with federal regulations. The information is voluntary and will not be used when considering you for employment with our company. Racial or Ethnic Group American Indian/Alaskan Asian/Pacific Islander African American/Black Hispanic/Latino White/Caucasian Other Gender Female Male Military Service Pre-Vietnam Era Vietnam Era Post-Vietnam Era Disabled Veteran How did you hear about us? Newspaper Company Employee Professional Publication Job Fair Placement Office Web Site Other __________________ Company Name Last First M.I. Street Address State ZIP Code