Affirmative Action Information Form

AFFIRMATIVE ACTION INFORMATION FORM

As a government contractor, most businesses support affirmative action programs. In compliance with government regulations, we are required to record the number of applications received by age and sex and to report these totals to the appropriate government agencies.

Please indicate your race or national origin, date of birth, and sex. This information will not be kept with your application and will be used only in accordance with the state and federal regulations.

This is an example of an affirmative action form.

DO NOT WRITE YOUR NAME ON THIS FORM.

You are not required to complete this form. Your application will be considered in the same manner whether this form is completed or not.

[ ] Male [ ] Female

[ ] American Indian

[ ] Asian

[ ] Black

[ ] Hispanic

[ ] Non-minority

[ ] Other (please specify) __________________________

Date of birth ________________________________

Warning:

These forms are provided AS IS. They may not be any good. Even if they are good in one jurisdiction, they may not work in another. And the facts of your situation may make these forms inappropriate for you. They are for informational purposes only, and you should consult an attorney before using them.