Applicant Data printable pdf download

Applicant Data

Goodwill Industries of Northern Michigan, Inc.

Applicant Data

• As employers/government contractors, we comply with applicable government regulations and

affirmative action responsibilities.

• Applicants are equally considered for all positions, and employees are treated during employment

without regard to race, color, religion, gender, national origin, age, martial or veteran status, medical

condition or disability.

• To help us comply with government recordkeeping, reporting and other legal requirements, please

fill out the applicant data record. We appreciate your cooperation.

• This data is for periodic government reporting, and will be kept in a confidential file separate from

the application for employment.

___________________________________________________________________________________

Please Print all Responses:

Date_______________________

Name___________________________________________________ Phone_______________________

Last

First

Middle

Address______________________________________________________________________________

Number

Street

City

State

Zip Code

Positions Applied For____________________________________________________________________

Referral Source________________________________________________________________________

Affirmative Action Survey:

Government agencies require periodic reports on the gender, ethnicity, disability, and veteran status of

applicants. This data is for analysis and affirmative action only. Submission of information is voluntary

Please check one:

___Male

___Female

Check only one of the following race/ethnic group:

___White

___Black

___Hispanic

___American Indian/Alaskan Native ___Asian/Pacific Islander

Check if any of the following apply to you:

___Vietnam Era Veteran

___Disabled Veteran ___Disabled Individual

Note to Supervisors: Please Remove Applicant Data Sheet and Submit to Human Resources immediately upon

receipt of

application. THIS WOULD NOT BE INCLUDED

Applicant Data