Affirmative Action Form
Affirmative Action Form
Affirmative Action Form
17TH AVENUE, SUITE 200, DENVER, CO 80203 888-835-9400 / 303-232-9800 PHONE 866-550-5430 FAX
APPLICANT AFFIRMATIVE ACTION INFORMATION It is E2s policy to provide equal employment opportunity to all qualified applicants for employment without regard to race, color, religion, national origin, sex, age, veteran status or disability. As an affirmative action employer under E.O. 11246 we invite all applicants to identify themselves as indicated below. COMPLETION OF THIS FORM IS VOLUNTARY AND IN NO WAY AFFECTS THE DECISION REGARDING YOUR APPLICATION FOR EMPLOYMENT. THIS FORM IS CONFIDENTIAL AND WILL BE MAINTAINED SEPARATELY FROM YOUR APPLICATION FORM. TYPE OR PRINT IN BLACK INK Name Last Position applied for (list only one) Please identify where you learned about an employment opportunity with this organization. ____ Newspaper ad ____ Recruiter ____ Tech school/college placement ____ State employment service Sex: ____ Male ___ Female ____ Employee referral ____ Other/please explain__________ ____ Temporary service First Middle Date
Race/ethnicity: ___ Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White (Not Hispanic or Latino) A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Black or African American (Not Hispanic or Latino) A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Asian (Not Hispanic or Latino) A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. American Indian or Alaska Native (Not Hispanic or Latino) A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Two or More Races (Not Hispanic or Latino) All persons who identify with more than one of the above five races.
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