Affirmative Action Survey
COMMUNITY OPTIONS & RESOURCES

An Equal Opportunity, Affirmative Action Employer

Please read carefully:
As an affirmative action employer, we must monitor our equal employment opportunity and affirmative action program, and report the results to government agencies. Please help us gather this information by identifying your sex, race or ethnicity, and disability status on this form.

Providing this information is completely voluntary. If you choose not to provide some or all of this information, you will not be subject to any negative or adverse treatment.

The information you provide will be used only to monitor our compliance with equal opportunity laws and regulations and for no other purpose.* When we receive this form, we will immediately place it in a confidential file separate from your application. If you wish, you may mail this form to us at COR, Box 333, Sherburn, MN 56171 attn: Human Resources in an envelope separate from the one that contains your application.

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Last Name: First Name:  Middle Initial(s)
Position Applied For:   Date Applied:
Phone:
Race/Ethnicity Select one or more:
American Indian/Alaskan Native A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
Asian Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
Black/African American Black or African American: A person having origins in any of the black racial groups of Africa
Hispanic/Latino Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race
Native Hawaiian/Pacific Islander Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
White White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa
       

Are you a person with a disability? Yes      No

Sex - Select One? Male      Female

* This form is not used for employment decisions. If you have a disability and need an accommodation so that you can perform the duties of the job for which you are applying, please notify us in some other manner.