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Additional Analysis/Terraloader/02-01-20/Document.txt
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Applicant Self-Identification Form
Applicants are considered for all positions without regard to race, color, sex, national origin, veteran status, or disability status. As an Affirmative Action/Equal Opportunity employer, First Atlantic Health Care complies with government regulations and affirmative action responsibilities.
Please complete the Applicant Self-Identification Form to assist us with government record keeping, reporting, and other legal requirements. The data is for analysis and affirmative action purposes. Submission of information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual. Completion of information below is voluntary. Thank you for your cooperation.
Name
Last First Middle
Name
Last First Middle
Position(s) Applied For:
Gender: X Male X Female
Race/Ethnic Group (Please check all that apply):