Affirmative Action Questionnaire

Voluntary Information

We consider employment without regard to race, color, religion, gender, ethnicity, citizenship, age, sexual orientation, mental and/or physical disabilities. This information will be used and kept confidential in accordance with applicable laws and regulations. Your cooperation is appreciated.

Position you are applying for:
Office where position is located:
Name (Last, First, Middle)
Telephone Number:
Address:
City/State/Zip

Male: Female:

Please check one of the following Equal Employment Opportunity identification:

Caucasian / European Descent African American Hispanic
Asian / Pacific Islander Native American

Thank you for your interest in KEMRON. Please let us know any other information you may find of importance.