Voluntary Application Information

AFFIRMATIVE ACTION/EQUAL EMPLOYMENT OPPORTUNITY DATA

The following information is used for research and reporting purposes for the City of Lakewood and the Federal Government in accordance with applicable laws and regulations. This information is voluntary and confidential and there will be no adverse consequences for not responding. This information is confidential and is kept separate from this application form. It will not be considered in the selection process. Please contact the Office of Human Resources if you have any questions relative to this form.

Check any that are applicable

Sex

Male
Female

Age

under 40
over 40

Ethnic Origin

American Indian/Alaskan Native
Black/African American (not of Hispanic origin)
White/Caucasian/European/North African/Middle Eastern
Hispanic/Puerto Rican/Mexican/Cuban/Central or South American
Asian American/Pacific Islander/Far Eastern or Southeastern Asia (i.e. China, Japan, Korea, Philippine Islands, Samoa)

Veteran Status

Non Veteran
Veteran
Veteran of Vietnam era

How did you hear of this vacancy?

Newspaper (please specify)

Website

Other Publication (please specify)

Other

Job posting at

Name

This field is for validation purposes and should be left unchanged.