EEO VOLUNTARY DEMOGRAPHIC FORM - Corner Home Medical

YOUR PRIVACY IS PROTECTED

This information is used to determine if our equal employment opportunity efforts are reaching all segments of the population, consistent with Federal equal employment opportunity laws. Responses to these questions are voluntary. Your responses will not be shown to the panel rating the applications, to the official selecting an applicant for a position, or to anyone else who can affect your application. This form will not be placed in your Personnel file nor will it be provided to your supervisors in your employing office should you be hired. The aggregate information collected through this form will be kept private to the extent permitted by law. See the Privacy Act Statement below for more information.

Completion of this form is voluntary. No individual personnel selections are made based on this information. There will be no impact on your application if you choose not to answer any of these questions.

Thank you for helping us to provide better service.
How did you learn about this position? (Check One):
- Agency Internet Site recruitment
- Private Employment Web Site
- Other Internet Site
- Job Fair
- Newspaper or magazine
- Agency or other Federal government on campus
- School or college counselor or other official
- Friend or relative working for this agency
- Private Employment Office
- Agency Human Resources Department (bulletin board or other announcement)
- Federal, State, or Local Job Information Center
- Other
Sex (Check One):
- Male
- Female
Ethnicity (Check One):
- Hispanic or Latino - a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
- Not Hispanic or Latino
Race (Check all that apply):
- American Indian or Alaska Native - a person having origins in any of the original peoples of North or South America (including Central America), and who maintains tribal affiliation or community attachment.
- Asian - 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, or Vietnam.
- Black or African American - a person having origins in any of the black racial groups of Africa.
- Native Hawaiian or Other Pacific Islander - a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific islands.
- White - a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
- Two or More Races – a person who primarily identifies with two or more of the above race/ethnicity categories.
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