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2. Position Applied For:
4. Sex:

   1. Female
   2. Male
5. Age:

   1. Under 18
   2. 18-39
   3. 40-65
   4. Over 65
6. Ethnic Category: (Select One)
   -- Select One --White: (not of Hispanic origin): a person having origins in any of the original peoples of Europe, North America, or the Middle East.Black: (not of Hispanic origin): a person having origins in any of the black racial groups of Africa.Hispanic: a person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origins, regardless of race.Asian or Pacific Islander: a person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or the Pacific Islands. American Indian or Alaskan Native: a person having origins in any of the original peoples of North America and who maintains cultural identification through tribal affiliation or community recognitionOther
8. Disability status, defined as:
   1) Has a physical or mental condition that substantially or materially limits a major life activity (such as walking, talking, seeing, hearing or learning); 2) Has a history of a disability (such as cancer that is in remission); 3) Is regarded as having such an impairment.
10. Do you claim disability status?

    1. Yes
    2. No
11. Where did you find out about this opening?
    -- Select One --Newspaper – Star TribuneCity PostingTelephone Inquiry Newspaper - LocalWord of MouthProfessional PeriodicalJob ServiceAgencyOther
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13. 1. Receive an email copy of this form.
14. Email address

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