Village of Rantoul Affirmative Action Data Record
Employees are treated during employment without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or other legally protected status.
As an employer with an Affirmative Action Program, we comply with government regulations, including Affirmative Action responsibilites 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 optional. 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.
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Last Name
First Name
Middle Name
Address
City
State
Zip
Referral Source
Advertisement
Relative
Friend
Government Employment Agency
Employee
Private Employment Agency
Walk-In
Other
Additional Information
Current Job:
Gender:
Male
Female
Ethnic Origin:
White
Black
Hispanic
Other
American Indian / Alaskan Native
Asian / Pacific Islander
Yes
Vietnam Era Veteran:
Disabled Veteran:
Birthdate:
Disabled Individual: