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2. Dear Job Applicant:

   As part of its Equal Employment Opportunity, the Town monitors certain data of applicants. Please assist us in compiling the data by completing, and returning this form. Thank you.

   Sincerely,
   Lloyd Gellineau
   Human Relations / Human Services Administrator
   
4. Name:
6. Address:
8. Gender:

   1. Male
   2. Female
   3. Transgender
9. Disabled:

   1. Yes
   2. No
11. Ethnicity:

    1. White
    2. Black or African American
    3. American Indian or Alaska Native
    4. Native Hawaiian or Other Pacific Islander

    1. Two or More Races
    2. Asian
    3. Hispanic or Latino
13. Title of Job Applied For:
15. Department:
17. Where did you learn about this job?

    1. Town Employee
    2. Newspaper
    3. Town Human Resources Office

    1. Community Agency
    2. Professional Publication
    3. Internet *
19. *If Internet, please specify site:
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field