Voluntary Self Identification Statement

We as an employer wish to voluntarily comply with various Federal, State, and Local Laws and Regulations which require us to monitor our Equal Employment Opportunity (EEO) status on a continuing basis.  In addition, we wish to voluntarily comply with the various laws and regulations which protect the handicapped, disabled veterans and Vietnam era veterans.  We desire for you to assist us in our monitoring efforts by completing this form.

Submission of this information by you is voluntary. Please be assured that you will no be subjected to any adverse treatment if you do not provide the information requested.

This information will not be kepts as a part of your Application of Employment, and will only be used to identify you for Government reporting purposes only.

We appreciate your assistance.

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