WASHINGTON COUNTY SHERIFF'S OFFICE
APPLICANT DATA RECORD

*COMPLETING THIS PAGE IS STRICTLY VOLUNTARY. THE INFORMATION CONTAINED HEREIN WILL BE KEPT IN A SEPARATE FILE AND WILL NOT BE USED FOR HIRING PURPOSES*

If you would like to complete the Applicant Data Record, print it out, complete the information and mail with your application.

Applicants are considered for all positions and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, physical or mental handicap.

As an employer, we comply with government regulations and affirmative action responsibilities. Solely to help us comply with government record keeping, reporting and other legal requirements, please fill out the Applicant Data Record. We appreciate your cooperation. This data is for periodic government reporting.

AFFIRMATIVE ACTION SURVEY

Government agencies require periodic reports on the sex, ethnicity, handicapped and veteran status of applicants.

THIS DATA IS FOR ANALYSIS AND AFFIRMATIVE ACTION ONLY AND IS VOLUNTARY.

Position(s) applied for__________________________________________

Date of Application______________________________________________

check one  ____Male  ____Female

check one  ____White  ____Black  _____Hispanic

            ____American Indian/Alaskan Native  ____Asian/Pacific Islander

check if any are applicable

____Vietnam Era Veteran  ____Disabled Veteran  ____Handicapped Individual