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Equal Employment Data

2. Please provide the information requested below. This information is needed to comply with the requirements of federal and state Equal Employment laws. This information will not be used in making employment decisions and will be kept separately from your application.
4. Please verify the position you applied for:*
6. Check the appropriate box:*

   1. Male

   1. Female

   1. Do not wish to respond
8. Check the appropriate box:*

   1. Not disabled

   1. Disabled

   1. Do not wish to respond
10. Check the appropriate box(es) for the racial or ethnic group with which you identify:*

    1. White (includes persons of Arabian descent)
    2. Black (includes Jamaicans, Bahamians, and other Carribeans of African, but not Hispanic or Arabian descent)
    3. Hispanic (includes persons of Mexican, Cuban, Puerto Rican, Central or South American, or other Spanish origin)
    4. Asian American (includes Pakistanis, Indians, and Pacific Islanders)
    5. American Indian (includes Alaskan natives)
    6. Do not wish to respond
12. How did you learn about this employment opportunity?*

    1. Newspaper*
    2. Radio/TV*
    3. Virginia Employment Commission
    4. City Web Site
    5. Word of Mouth*
    6. Telephoned Our Office
    7. Professional Organization*
    8. Other*
    9. Do not wish to respond
14. Please specify*
Leave This Blank:


16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

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