In order to compile data for reporting requirements under federal law, Atlantic Services Group, Inc. invites you to voluntarily complete the following information. This information will be used solely for Affirmative Action record-keeping purposes and will be kept in a confidential file, separate from the employment application.
First Name (required)
Last Name (required)
Date
Please check all the appropriate boxes
Sex Female Male Refuse to Answer
Race/Ethnicity American Indian Asian African American Hispanic White Multiple Races Other Refuse to Answer
Disabled Individual - Defined as one who either has a physical or mental impairment that substantially limits one or more of the person’s major life activities, has a record of such impairment, or is regarded as having such impairment. Yes No Refuse to Answer
Disabled Veteran - Defined as a veteran who is entitled to disability compensation under laws administered by the Veterans Administration for disability rated at 30% or more, or a person whose discharge or release from active duty was for disability incurred or aggravated in the line of duty. Yes No Refuse to Answer
Vietnam Era Veteran - Defined as a veteran who served in active duty more than 180 days, at least partly between August 5, 1964 and May 7, 1975 and did not receive a dishonorable discharge. Yes No Refuse to Answer
Southwest Asia Theater of Operations Veteran - Defined as a veteran who served in active duty from August 2, 1990 - January 2, 1991 (Persian Golf) Yes No Refuse to Answer
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