Form Cc-305 - Confidential Voluntary Questionnaire printable pdf download

Form Cc-305 - Confidential Voluntary Questionnaire

CONFIDENTIAL VOLUNTARY QUESTIONNAIRE

As an equal opportunity employer and government contractor, we are obligated by Federal regulations

to monitor our employment practices to ensure nondiscrimination, measure the effectiveness of our

affirmative action program and produce required reports. To assist in this process, you are invited to

complete this questionnaire which will be greatly appreciated.

You are

required by law to provide the information requested. If you elect to provide the data, it

will be detached from your application, be kept confidential, and used only in accordance with

government regulations and Affirmative Action Policy. Refusal to provide this data will not adversely

affect consideration for employment.

Race/Ethnic Group D Hispanic or Latino

White (not Hispanic or Latino)

D Black or African American (not Hispanic or Latino)

D Asian (not Hispanic or Latino)

D Native Hawaiian or Other Pacific Islander (not Hispanic or Latino)

D American Indian or Alaskan Native (not Hispanic or Latino)

D Two or more races (not Hispanic or Latino)

Sex:

C Male

C Female

VETERANS STATUS

Served on active duty during any war, campaign, or expedition for which a campaign badge was authorized?

YES

Received the Armed Forces Service Medal?

YES

Recently separated veteran (discharged or released from active duty within 3 years)?

YES

Disabled Veteran?

YES

APPLICANTS NAME (please print)

Signature

Date:____________________________

Form Cc-305 - Confidential Voluntary Questionnaire