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Applicant Data Record Form 

Applicants for employment are considered for all positions, and employees are treated during employment without regard to race, color, religion, national origin, sex, age, martial or veteran status, or disability.

As a local government employer, we comply with government and equal employment regulations. Please assist us in complying with government record-keeping reporting and other local requirements by completing the questions listed below. Your responses will be used for statistical purpose only and will be kept in a confidential file, separate from the employment application. The information you supply is voluntary and will not be used for employment purposes.

 

 

         
           
© 2005-2008 Integrated Digital Systems/ScanAmerica, Inc

 
   
*Date:
/ /
*Position Applied For:
*Name:
*Referral Source:
Advertisement Friend / Relative Agency
Other
*Check One:
Male Female
*Check One:
White
Black
Hispanic
Asian / Pacific Islander
American Indian / Alaskan Native
*Check if any are applicable:
Vietnam Era Veteran
Disabled Veteran