Equal Employment Opportunity Form

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Equal Employment Opportunity Form
Application Information
YOUR LOGO HERE
Full Name:
Address:
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