SR Weidema Affirmative Action Form
Employees are treated during the hiring process and employment without regard to race, color, creed, religion, national origin, sex, sexual orientation, disability, age, marital status, familial status, membership or activity in a local human rights commission, or status with regard to public assistance. As an employer with an Affirmative Action Program, we comply with government regulations, including Affirmative Action responsibilities where they apply.

The purpose for this Data Record is to comply with government record keeping, reporting and other legal requirements. Periodic reports are made to the government on the following information. The completion of this Data Record is option. If you choose to volunteer the requested information please note that all Data Records are kept in a Confidential File and are not a part of your Application for Employment or personnel file. Please note:

YOUR COOPERATION IS VOLUNTARY. Inclusion or exclusion of any data will not affect any employment decision.
Sign in to Google to save your progress. Learn more
Position for which you are applying:
Ethnic Origin:
Gender
Clear selection
Veteran Status
Are you a Vietnam-era veteran who served on active duty for more than 180 days during the Vietnam-era?
Clear selection
Are you a disabled veteran?
Clear selection
Other qualifying veteran:
Qualification:
Dates:
Disability
Do you have a disability or any physical condition which may limit your ability to perform the position for which you have applied?
Clear selection
Do you request that S.R. Weidema, Inc., consider any special arrangements to accommodate this condition?
Clear selection
If yes, please describe the job-related functional limitations that result from the impairment and any special accommodation or method or procedures, which would allow you to perform the duties of the position for which you are otherwise qualified.
Your Name:
Date
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms