Affirmative Action Information Form {HR-723}

AFFIRMATIVE ACTION INFORMATION FORM As a government contractor, we support affirmative action programs. In compliance with government regulations, we are required to record the number of applications received by age and sex and to report these totals to the appropriate government agencies. Please indicate your race or national origin, date of birth, and sex. This information will not be kept with your application and will be used only in accordance with the state and federal regulations. DO NOT WRITE YOUR NAME ON THIS FORM. You are not required to complete this form. Your application will be considered in the same manner whether this form is completed or not. [ ] Male [ ] Female [ ] American Indian [ ] Asian [ ] Black [ ] Hispanic [ ] Non-minority [ ] Other (please specify) Date of birth American LegalNet, Inc. 251 www.FormsWorkFlow.com