Job Position & Name


Name is required and must be a string.
Name is required and must be a string.
Address
Address is required.
City is required.
State is required.
Zipcode is required.
Contact
Email Address
An email address is required.
Primary Phone #
Please enter a properly formatted telephone number.
Alternate Phone #
Please enter a properly formatted telephone number.
General Information
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From
To
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Date available for work

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Yes No Questions
1. Are you Hispanic or Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race)? If you checked “Yes” to Question 1, please do not proceed further. If you checked “no,” please proceed to Question 2.
2. Do you identify with Two or More Races (Not Hispanic or Latino) as defined below?
3. Please select one or more of the following race designations as defined below.





Definitions of Race/Ethnicity Designations:

  1. White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
  2. Black or African American (Not Hispanic or Latino) – A person having origins in any of the black racial groups of Africa.
  3. 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 Islands.
  4. Asian (not Hispanic or Latino) – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, Indian, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
  5. American Indiana or Alaska Naïve (Not Hispanic or Latino) – A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
  6. Two or More Races (Not Hispanic or Latino) – All persons who identify with more than one of the above five races.

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