The Town of Sylva is an Equal Opportunity Employer. Please complete this form in order for us to comply with the reporting requirement for the Equal Employment Opportunity Commission. This form will be separate from your employment application. Other than the information you provide in Section I, the information on this form will not be used in any way in our selection process or for any personnel action following employment. It will be maintained in personnel files which must be kept confidential under State law. Public disclosure of this information without your consent would be a violation of state general statutes.

Your first name:

Your last name:

Your middle name:

Position applied for:

Date of Application:

Sex:
MaleFemale

INVITATION TO SELF-IDENTIFY

Hispanic or Latino: a person of Cuban, Mexican, Chicano, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.White: a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.Black or African American: a person having origins in any of the black racial groups of Africa.Asian: a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.Native Hawaiian or Other Pacific Islander: a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.American Indian or Alaska Native: a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.Two or More Races: a person who primarily identifies with two or more of the above race/ethnicity categories.

DRUG SCREENING

All FINAL applicants must pass a drug screening process. Further information will be provided at the appropriate time in the employment process.

SELECTIVE SERVICE REGISTRATION

If male and age 18 to 26, have you registered for Selective Service? If not, you will have 30 days to comply if selected for a position as required by Federal law.
YesNoN/A

CERTIFICATION

I certify that I have read and understand the information contained on this form, complied with the instructions provided, and have done so truthfully to the best of my knowledge.

Please sign in the grey area below:

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