APPLICANT EQUAL EMPLOYMENT OPPORTUNITY SELF-IDENTIFICATION FORM
The United States government requires Digital Solutions, Inc. (“DSI”) to identify, where possible, the gender, race, and ethnicity of each job applicant. DSI has developed this voluntary self-identification form to comply with the government requirements. It is DSI’s understanding the information in this survey will be used by DSI for government required analyses and reporting purposes only. Submission of this information is voluntary, and this form will be kept separate from your employment application. Your responses to the questions below will have no affect whatsoever on DSI’s decision concerning your job application. Sex: Race/Ethnicity: (ONLY check ONE) ______ Male ______ Female
______ Hispanic or Latino For the below, check if NOT Hispanic or Latino: ______ White ______ Black and African American ______ Native Hawaiian or Pacific Islander ______ Asian ______ American Indian or Alaskan Native ______ Two or More Races
____________________________________________ Last Name First Name Middle Initial Position Applied for (list one only): ___________________________________ Date: _________________________ Signature: _____________________
10/2007