VOLUNTARY AFFIRMATIVE ACTION INFORMATION

Traffic Control Devices, Inc. considers applicants for all positions without regard to age, color, disability, national origin, race, religion, veteran status or any other legally protected status.


Date____/____/____   Position(s) applied for ____________________________________

Referral Source: ___Advertisement   ___Employee   ___Walk-in   ___Relative   

    ___Employment Agency      ___Other    Name of Source  (if applicable) ____________ 

Applicants Name_____________________________________________________________
                                  Last                              First                          Middle
Address ________________________________________________________________
              Street                           City                   State                   Zip Code

We comply with government regulations including Affirmative Action.

In an effort to comply with requirements regarding government record keeping, reporting 
and other legal obligations, we ask that you complete this survey.

Please be advised that this survey is not part of your official application. It is considered confidential information that will not be used for hiring.

Check one:     ____Male      ____Female

Check one of the following Race/Ethnic Group:

 ____American Indian/Alaskan Native   ____Asian    ____Black   ____Hispanic   ____White

SPECIAL NOTICE TO VIETNAM ERA VETERANS AND INDIVIDUALS WITH PHYSICAL OR MENTAL HANDICAPS OR DISABILITIES:

Government contractors subject to the Vietnam Era Veterans Readjustment Act of 1974 and the Rehabilitation Act of 1973 are required to take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and qualified handicapped individuals.

You are invited to volunteer this information, if you qualify, to assist in proper placement and determining reasonable accommodation. This information is considered confidential, and refusal to provide this information will not adversely affect your consideration for employment.

IF YOU SO WISH TO BE IDENTIFIED, PLEASE CHECK APPLICABLE STATUS:

___VIETNAM ERA VETERAN  ___DISABLED VETERAN   ___HANDICAPPED INDIVIDUAL 

To be completed by applicant - NOT FOR INTERVIEW PURPOSES - To be filed separately from application. This information is used solely to satisfy Affirmative Action requirements of Section 503 of the Rehabilitation Act or necessitated by other Federal Laws.