The following information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect any consideration you may receive for employment. Government agencies require periodic reports on sex and ethnicity of applicants.

This data is for analysis and affirmative action only.

Government contractors are subject to Section 402 of the Vietnam Era Veterans Readjustment Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and other eligible veterans, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals, and the Jobs for Veterans Act.

If you are a special disabled veteran, a Vietnam Era Veteran, recently discharged veteran or other protected veteran, or have a physical or mental handicap, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job in a proper and safe-manner.

If you wish to be identified, please initial below.