EEO/Affirmative Action Voluntary Survey
Name:
Position Applied For:
Referral Source:
(check one)
Employee Referral
Name:
Ad
Source:
Government Employment Agency
Private Employment Agency
Other
Gender:
(check one)
Male
Female
Race:
(check one that best applies)
White
Black/African American
Asian/Pacific Islander
Hispanic
American Indian/Alaskan Native