VOLUNTARY EEO IDENTIFICATION FORM

Note: This form is voluntary and confidential. Submission of information is voluntary, and failure to provide will not subject you to any adverse treatment.

To all applicants and employees: To enable us to meet government reporting regulations and maintain an Affirmative Action Plan, Holistic Home & Hospice requests that you complete this personal data form.

Information will be used solely for government reporting purposes and will be detached and kept separate from your application. Any information that you choose to provide will not be considered by the company for employment purposes and will be treated as personal and confidential.

Submission of information is voluntary, and failure to provide will not subject you to any adverse treatment. Your cooperation is appreciated.



Gender / Ethnic Group

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, Central American, or other Spanish culture or origin regardless of race. This does not include persons of Portuguese descent or persons from Central or South America who are not of Spanish origin or culture.


Race

Veteran Status

Federal regulations define a special disabled veteran as one who (1) is entitled to compensation under laws administered by the Veteran's Administration for a disability rated at 30% or more, or (2) was discharged or released from active duty because of a service-connected disability.

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