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 and submit the requested information below or mail the completed form to:   J.H. Findorff & Son Inc., Attn: Human Resources, 300 S. Bedford St., Madison, WI  53703. Your cooperation with this effort is very much appreciated.

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.

Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. If you are hired, Findorff will use your I-9 form information and E-Verify to meet this requirement.

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 Hispanic or Latino) Black or African American Hispanic or Latino Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Two or More Races (not Hispanic or Latino)
Gender:  Male    Female
Disabled:  Yes    No