VOLUNTARY AFFIRMATIVE ACTION INFORMATION

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Qualified applicants are considered for employment, and employees are treated during employment, without regard to race, color, religion, sex, national origin, age, marital status, medical condition or disability.

To help us comply with federal / State Equal Employment Opportunity record keeping and other legal requirements, please answer the questions below. This information will in no way be used in the decision to hire or promote.
Date
Position applied for
Name
Age
Birthdate
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Referral Source (Please be specific)
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Employee
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Ethnic Group: Hispanic or Latino
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