Applicant Voluntary Self Idenitfication

Certain of our clients who are contractors with the federal government are required to solicit the race, gender, disability, and military status of those who are considered for positions with them. These clients have asked us to solicit that same information from candidates who might be considered for referral to that position. Therefore, we are asking that you voluntarily check the appropriate boxes below.

Neither the answers you provide, nor your failure to provide answers, will have any effect whatsoever on our decision to refer you for any position and the information you provide will be kept separate from that information used by us to evaluate your qualifications. Your completion and return of this form to us is purely voluntary.

* = Required Field

Gender Male  Female
RACE/ETHNICITY (Pick one that is most applicable)
White (not Hispanic or Latino) A person with origins in any of the original peoples of Europe, North Africa, or the Middle East who is not of Hispanic origin.
Black or African American A person with origins in any of the black racial groups of Africa who is also not of Hispanic or Latino origin.
Asian A person with origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or the Pacific islands, this includes, for example, Cambodia, China, India, Japan, Korea, Malaysia, the Philippine Islands, Thailand, and Vietnam.
American Indian or Alaskan Native A person with origins as in any of the original peoples of North America and who maintains cultural identification through tribal affiliations or community recognition.
Hispanic or Latino (All races) A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Island.
Two or More Races (Not Hispanic or Latino)
Yes, I have a disability (or previously had a disability).
No, I do not have a disability.
I do not wish to answer.
No Service
Active Reserve
Inactive Service
Disabled Veteran
Other Protected Veteran
Armed Forces Medal Veteran
Recently Separated Veteran

Disabled veteran means a disabled veteran who has the ability to perform the essential functions of the employment position with or without reasonable accomodation.

Other protected veteran means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized, under the laws administered by the Department of Defense.

Recently separated veteran means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval or air service.

Armed Forces service medal veteran means any veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

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