EEOC Survey Please enable JavaScript in your browser to complete this form. - Step 1 of 2EEO/AA PRE-OFFER VOLUNTARY SELF-IDENTIFICATION INFORMATIONTerrebonne ARC is an EEO/Affirmative Action EmployerWe consider all application for positions without regard to race, color, religion, sex, national origin, age, mental or physical disabilities, veteran status, and all other characteristics protected by law. We also comply with all applicable laws including E.O.11246 and Vietnam Era Readjustment Assistance Act of 1974 governing employment practices and do not discriminate on the basis of any unlawful criteria. As a federal government contractor, we take affirmative action on behalf of protected veterans. To be completed by applicant on a voluntary basis. Not for interview purposes. To be filed separately from application. In an effort o comply with requirements regarding government recordkeeping, reporting, and other legal obligations, which may apply, we invite you to complete this applicant data survey. Failure to provide information will not subject you to any adverse personnel decision or action. Your cooperation is appreciated. Please be advised that this survey is not a part of your official application for employment. It will not be used in any hiring decision. The information will be used and kept confidential in accordance with applicable laws and regulations. REFERRAL SOURCEState Workforce AgencyCompany WebsiteAdvertisementOnlineEmployee Referral:Employment Agency:School:Other:NextAPPLICANT INFORMATIONApplicant NameFirstMiddleLastAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHome Phone NumberBusiness Phone Number/Cell Phone NumberETHNICITY/RACE CATEGORIESPlease check one of the descriptions below corresponding to the ethnic group with which you identify.Hispanic or Latino (or identify a race listed below)White (Not Hispanic or Latino)Black or African American (not Hispanic or Latino)Native Hawaii or Other Pacific Islander (not Hispanic or Latino)Asian (not Hispanic or Latino)American Indian or Alaska Native (not Hispanic or Latino)Two or more races (not Hispanic or Latino)Do not wish to identifyDEFINITIONSHispanic 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 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 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 Islands, Thailand, and Vietnam. Native American 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 identify with more than one of the above five races. GENDER CATEGORIESMaleFemaleDo Not Wish to IdentifyPROTECTED VETERAN CATEGORIESProtected VeteranNot a Protected VeteranDo Not Wish to ItentifyPROTECTED VETERAN CATEGORY DESCRIPTIONSA “Disabled Veteran” is one of the following: (a) a veteran of the U.S. Military ground, naval, or air service who is entitled to compensation (or who, but for the receipt of military retired pay, would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or (b) a person who was discharged or released from active duty because of a service-connected disability. An “Active Duty Wartime or Campaign Badge Veteran” means a veteran who served on active duty in the U.S. Military ground, naval, or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. A “Recently Separated Veteran” means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. Military ground, naval, or air service. An “Armed Forces Service Medal Veteran” means a veteran who, while serving on active duty in the U.S. Military ground, naval, or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.Email *Submit
