Recruitment Questionnaire
This information is requested by State and Federal Agencies. This form will be removed from your employment application and kept
separate and confidential. Your cooperation in volunteering this information is appreciated. If you do not want to volunteer this
information., you do not have to; check the Decline to State option.
Position applied for:
Ethnic Background (check one only)
American Indian or Alaskan Native - all persons having origins in any of the original peoples of North America and who maintain
cultural identification tribal affiliation or community recognition
Asian or Pacific Islander - all persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands, India, Pakistan,
Guam, and Samoa.
Black (not of Hispanic origin) - all persons having origins in any of the Black racial groups of Africa
Hispanic - all persons of Mexican, Puerto Rican, Cuban, Central or South America, or other Spanish culture or origin, regardless of
race.
White (not of Hispanic origin) - all persons having origins in any of the original peoples of Europe, North Africa, or the Middle East
Other (Please specify):
Decline to State
Gender (Sex)
Male
Female
Age
Are you 40 years of age or over?
Yes
No
Disability Accommodation for Testing
Human Resources will make an effort to provide reasonable accommodation to disabled candidates in the examination process.
If you have special needs, please notify the Recruitment Office at least five (5) working days prior to the examination by calling
(510) 477-7500.
12/2006
Union Sanitary District is an Equal Opportunity Employer