As employers and government contractors, we comply with government regulations and affirmative action responsibility. Solely to help us comply with affirmative action record keeping, reporting and other legal requirements, please complete the survey below. This information will not be used for hiring, placement, or other decisions related to the terms and conditions of employment. This document will be kept in a confidential file, separate from applicant and personnel files.

Your cooperation is voluntary. Inclusion or exclusion of any data will not affect any employment decision.

Birthdate: MO DAY YEAR
Gender: Male or Female
Ethnicity/Race:
American Indian or Alaska Native
Asian
Hispanic or Latino
Black or African American
Hawaiian Native or other Pacific Islander
White
Other
Decline Response

Definitions:

• White (Not of Hispanic origin) All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.
• Black or African American- All persons having origins in any of the Black racial groups of Africa.
• Hispanic or Latino- All persons of Mexican, Puerto Rican, Cuban Central or South American, or other Spanish culture or origin, regardless of race.
• Asian or Pacific Islander- All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands, and Samos.
• American Indian or Alaskan Native- All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.

Disabled: yes no US Veteran: yes no Disabled US Veteran: yes no
Armed Forces Service - Medal Veteran: yes no -- Newly Seperated: yes no

I authorize Standlee Hay Company to release to any person, firm, entity or organization with which I may seek future employment, any truthful information concerning my work experience with the Company. I hereby release and hold the Company harmless from any claim for releasing any truthful information within its knowledge and/or records.

I understand that any job offer that may be extended to me may be contingent upon the successful completion of a drug and alcohol test.

I certify that the answers given by me to the foregoing questions and during any interview are true and correct without consequential omissions. I understand that if employed omissions and/or false statements on this application or during any interview may result in dismissal. I understand and acknowledge that if hired, my employment is for no definite period and either the Employer or I may terminate our relationship at will at any time, without notice or for any reason. This employment application does not constitute an employment contract between me and the Company. I have had an opportunity to have my questions about this statement’s content and intent answered. I understand its terms and agree to them.