Affirmative Action Questionnaire

This form will be detached from your application and will be kept separate and confidential. This employer is subject to certain non-discrimination and affirmative action recordkeeping and reporting requirements which require the employer to invite applicants to voluntarily self-identify their race/ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable federal laws, executive orders, and regulations, including those which require information to be summarized and reported to the Federal Government for civil rights enforcement purposes.

Confidential Information – To be removed from employment packet!

Kamminga & Roodvoets, Inc. is an equal opportunity employer

Gender (Check One)
State (Check One)(Required)
Race/Ethnic Heritage
(Please check the one box that describes the race/ethnicity category with which you primarily identify.)
*If you choose not to self-identify your race/ethnicity, the federal government requires the employer to determine this information by visual survey and/or other available information.

MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.
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