Voluntary Affirmative Action Survey
Instructions This company is an Equal Opportunity Employer. As required by law, we must record certain information to be made part of our Affirmative Action Program
Applicants for employment are also invited to participate in the Affirmative Action Program by reporting their status as handicapped, disabled veteran, veteran of the Vietnam era or other minority. In extending this invitation you are also advised that: (a) workers (applicants) are under no obligation to respond, but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for the necessary information to include in our Affirmative Action Program. We are a company that values diversity. We actively encourage women and minorities to apply.
Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment.
Please complete the information requested below. Thank you for your cooperation. Section 1: General Applicant Information
Position Applied For
Location: Select One CT - Danbury CT - Southbury CT - Waterbury GA - Albany GA - Americus GA - Atlanta GA - Douglas GA - Gainesville GA - Region 1 GA - Region 2 GA - Region 4 GA - Region 6 GA - Savannah GA - Vadosta IN - Connersville, IN area IN - Crown Point IN - Fort Wayne, IN area IN - Hobart, IN area IN - Indianapolis IN - Kokomo IN - Lafayette IN - Marion IN - Richmond, IN area IN - South Bend, IN IN - Southern Indiana MI - Michigan MO - St. Louis, MO NE - Lincoln NE - Omaha NJ - Branchburg NJ - Bridgewater NJ - Monmonth County NJ - Somerset County NM - Albuquerque, NM NM - Farmington NM - Gallup NM - Santa Fe, NM OH - Cincinnati, OH area OH - Cleveland, OH area OH - Columbus, OH area OH - Dayton, OH area OH - Lima, OH area OH - Northwest OH area OH - Springfield OH - St. Marys, OH area OH-Delaware TN - Memphis TN - Nashville Section 2
Please check all that apply View Definitions
Race or Ethnic Identity
Signature (Last 4 of SSN)
Or: How did you hear of our opening?