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 employerName(Required) First Last Complete Title of Position Applied For(Required) Gender (Check One) Male Female State (Check One)(Required) Michigan Florida Race/Ethnic Heritage Hispanic or Latino - A person of Cuban, Mexican, Chicano, 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 Africa. 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 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 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 tribal affiliation or community attachment. Two or More Races (not Hispanic or Latino) - All persons who primarily identify with more than one of the above races. (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.Digital Signature(Required) Date(Required) MM slash DD slash YYYY CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
