Job Application Affirmative Action

This form is a REQUIRED part of your application.

Information as to race, sex, disability, or veteran status is voluntary. However, it is REQUIRED that you at least fill in your name, address, and the job you're applying for.

Rural Resources Community Action is an Equal Opportunity Employer. In order to assess our Affirmative Action Program, you are being requested to complete the following information. This information will be used for statistical purposes only and will be kept separately from all other information contained in your job application packet. It will not be available to persons involved in the selection process. This form has been approved by the Washington State Human Rights Commission.

Name *

Position Applied For *

Address *

Email *

Phone

Sex

Male

Female

Ethnic Background

Check descriptor applicable

Non-Hispanic

Hispanic or Latino

Racial Background

Check descriptor applicable

White (Not Hispanic or Latino)

Black or African American (Not Hispanic or Latino)

Asian (Not Hispanic or Latino)

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)

American Indian or Alaska Native (Not Hispanic or Latino)

Two or more races (Not Hispanic or Latino)

To Vietnam Era Veterans, Disabled Veterans, and Individuals with physical or mental disabilities:

Government contractors subject to the Vietnam Era Veterans Readjustment Act of 1974 and the Rehabilitation Act of 1973 are required to take affirmative action to employ and advance in employment qualified disabled veterans of the Vietnam era and qualified disabled individuals.

You are invited to volunteer this information to assist in proper placement and determining reasonable accommodations if you qualify for employment. This information will be considered confidential. Refusal to provide this information will not adversely affect your consideration for employment.

If you wish to be identified, please check if any of the following are applicable:

Phone

This field is for validation purposes and should be left unchanged.

Thank you for applying!

There's one more important step!

This form is a REQUIRED part of your application.

Connect with rural Resources

RURAL RESOURCES • 956 SOUTH MAIN • COLVILLE, WA 99114

This institution is an equal opportunity provider and employer.