Applicant Voluntary Self-Identification of Gender and Race/Ethnicity
Please read all instructions carefully before completing the form below.This self-identification form is optional. Your cooperation is appreciated.
Anti-discrimination Notice
It is unlawful employment practice for an employer to fail or refuse to hire or to discharge any individual, or otherwise to discriminate against any individual with respect to that individual's terms and conditions of employment, because of such individual's race, color, religion, sex, national origin or other protected categories by law.
Suntiva Executive Consulting is subject to certain governmental record keeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, we invite applicants to voluntarily self-identify their race, ethnicity and gender. Submission of this information is voluntary, and refusal to provide it will not subject you to any adverse treatment and is not a part of your official application for employment. The information will not be used in any hiring decision. The information provided will be kept confidential and may only be used in accordance with the provisions of the applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.
Please answer the following questions.
Name: Date:
Position applying for:
Gender
Male
Female
What is your race/ethnicity? You may mark only one box.
Hispanic or Latino: a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
White (Not Hispanic or Latino): a person having origins in any of the original peoples of Europe, the Middle East, or North America.
Black or African American (Not Hispanic or Latino): a person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino): a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
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, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
American Indian or Alaska Native (Not Hispanic or Latino): a person having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment.
Two or More Races (Not Hispanic or Latino): all persons who identify with more than one of the above races