J. H. Findorff
"What most impressed us were the Findorff people. Everyone had a genuine sense of pride in their work. That was a real comfort."

William T. Montei
President & CEO
Physician's Insurance Company of Wisconsin
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Invitation to Self-Identify

For Affirmative Action Related Purposes

J.H. Findorff & Son Inc. prepares affirmative action plans that cover females, minorities, and certain other individuals. This survey is meant to help the company fulfill certain objectives in these affirmative action plans.

Thank you for your interest in employment opportunities at J.H. Findorff & Son Inc. We have received your resume and will be reviewing your qualifications and experience within the next two weeks. If your skills and qualifications appear to be a strong match to an available position, we will contact you within three weeks.

In an effort to compile data for our affirmative action plan, we ask that you complete the requested information below. Your cooperation with this effort is very much appreciated. You can either email your information back to sender or mail the completed form to: J.H. Findorff & Son Inc., Attn. Neelam Kerkela, 300 S. Bedford St., Madison, WI 53703.

PLEASE NOTE: You are not required to complete any part of this form. The decision not to complete this form will not affect any opportunity for employment or any benefits with the company. Any information you provide in this survey will be kept confidential and will not be used in any way that may adversely affect your employment with this company.

Name: Date:
Position you are applying for:
How were you referred to the company?
AFFIRMATIVE ACTION RELATED DATA (Please check appropriate boxes)
Race/Ethnic Origin: White (not of Hispanic origin)
Black/African American
Hispanic
Asian/Pacific Islander/Indian Subcontinent
Native American/Alaskan Native
Gender:  Male    Female
Disabled:  Yes    No