Voluntary EEO Self-Identification Form

As employers/government contractors, we comply with government regulations pertaining to equal employment opportunity, affirmative action, veteran status, & disabilities. We would greatly appreciate you completing this form to help us comply with our reporting requirements; however, it is not required for employment & will not affect the hiring decision in any way.

**This data is for the purpose of periodic government reporting & will be kept in a strictly confidential file separate from the application for employment.

Name

First Name

Last Name

Today's Date

YYYY

Position Applied For:

Referral Source

Preferred Gender

Race/Ethnicity

Please only check one. If you identify as more than one race/ethnicity, please choose the option that says "Two or More Races".

Veteran Status/Disability

Please check all that apply.

Disabled Veteran

Recently Separated Veteran

Armed Forces Service Medal Veteran

Other Protected Veteran

Individual with a Disability

None of the above

Voluntary EEO Self-Identification Form

Kemp Sigmon Construction Co., Inc.

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