2. Due to Federal Government requirements that we report applicant information, we ask that you complete this Applicant Survey. Failure to complete the survey will in no way adversely affect your opportunity for employment and completion of the survey form will in no way enhance your opportunity for employment. This form will be kept separate from the Application for Employment and will not be filed or referred to a department with your application. Your cooperation in completing the Applicant Survey Form is appreciated.
4. Name
5. Position
7. Gender

   1. Male
   2. Female
8. Date of Birth
10. Ethnic Group
    -- Select One --WhiteBlack or African AmericanNative Hawaiian or Other Pacific IslanderTwo or more races (not Hispanic or Latino)Hispanic or LatinoAsianAmerican Indian or Alaskan Native
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12. 1. Receive an email copy of this form.
13. Email address

    This field is not part of the form submission.

14. Submit

* indicates a required field