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Thank you for your interest in working for Region V Services.

Below you will find a affirmitave action form, please fill out and submit or check the box that says decline.

 

INVITATION TO SELF IDENTIFY


Region V Services is an Equal Opportunity Employer.  We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, veteran status or any other legally protected class.  As required by law, we must record certain information to be made a part of our Affirmative Action Program.  Applicants are invited to participate in the Affirmative Action Program by reporting their status as minority, disabled veteran or other veteran status, or other disabled.  In extending this invitation you are advised that:  1) you are under no obligation to respond, but may do so in the future if you choose; 2) responses will remain confidential within the Human Resources Department; and 3) responses will be used only for the necessary information to include in our Affirmative Action Program.

 

In an effort to help us comply with legal record keeping requirements regarding Affirmative Action, we ask that you complete the information requested below.  Please be advised that your completion of this form is NOT part of your official application for employment.  It is considered information that will not be used in any hiring decision.  Refusal to provide this information will have not bearing on your application and will not subject you to any diverse treatment.  If you choose to participate in our Affirmative Action Program by completing this form, we thank you for your cooperation.


Section 1: General Applicant Information
Section 2: Referral Source - Please check one
Section 3: Applicant Affirmative Action Data
A. Gender
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C. Race/National Origin
- Check the box below that corresponds to the category that best identifies your race/ethnicity. Important: If you check the "Two or more races" box, please also check ALL Sections that identify your race/ethnicity. For example: If you identify yourself as Asian and Black, you would check 3 boxes - one for Black, one for Asian and one for Two or more races.
D. Veteran Status
– Please check all boxes below that apply. Identification of veteran status is essential for effective affirmative action data collection and analysis. If you choose to identify your veteran status, the information you provide will be used for statistical purposes only and will not affect your employment in any
E. Disability Status
– Please check the box below if applicable. Self-identification of disability status is essential for effective affirmative action data collection and analysis. If you choose to self-identify your disability status, the information you provide will be used for statistical purposes only and will not effect your employment in any way.
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