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Equal Employment Opportunity Survey
This voluntary Equal Employment Opportunity (EEO) self-identification form serves to fulfill the governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. This is a voluntary self-identification form used to collect confidential gender and racial/ethnic information and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws. When reported, data will not identify any specific individual.
PLEASE READ CAREFULLY If you have any questions regarding the following statements, please ask for assistance by calling (941) 960-3997. By typing my full name in the box below I hereby certify that the following statements, as well as those on the previous questions, to the best of my knowledge are true and correct and that they are all given of my own free will. I agree that any misstatement(s) or omission(s) as to material facts will constitute grounds for unfavorable consideration or dismissal from employment. I authorize you to communicate with my former employers, schools, officials and persons named as references unless specified by the above question. I hereby release all employers, schools and individuals from any liability for any damage whatsoever resulting from giving such information. I understand that, as this organization deems necessary, I may be required to work overtime hours or hours outside a normally-defined work day or work week. If employed, I understand and agree that such employment may be terminated at any time and without any liability to me to continue salary, wages, or employment-related benefits.