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State of Texas Application for Employment (Fillable) Page 5
State of Texas Application for Employment (Fillable)
(0909)
APPLICANT EEO DATA FORM
The information requested is optional and is being collected for the purpose of reporting to Federal and Equal Employment
Opportunity Agencies and will not be considered as part of the application for employment. It will be separated from the application.
1. Job Posting Number
2. Last Name
(Type or Print) First Middle
3. Address
City
State
ZIP Code
4. Daytime Phone
(
)
5. Work Phone
( )
6. Sex
M-Male
F- Female
7. Birth Date
8. Ethnic Origin
Asian/Pac. Am. Ind/
W-White B-Black H-Hispanic P-Islander I-Alaskan O-Other
9. Veteran
Yes
No
10. Surviving Spouse of Veteran
who has not remarried
Yes
No
11. Orphan of Veteran
Yes
No
12. Former Texas Foster Youth
25 yrs of age or younger
Yes
No
13.
How did you
first
find out about this job
01 - Other State Employee
02 - Job Fair
03 - Professional Publication
04 - Recruitment Poster
05 - Television
06Newspaper
Name of Newspaper
07 - College/University Career Day
08 - Human Resource/Personnel Office
09Radio
10 - Agency Web Site - Internet
11 - WorkInTexas.com
12 - Other (specify):
X
Signature Applicant
Date
White (Not of Hispanic origin)All persons having origins in any of the original peoples of Europe, North Africa, or the Middle
East.
Black (Not of Hispanic origin)All persons having origins in any of the Black racial groups of Africa.
HispanicAll persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless
of race.
Asian or Pacific IslanderAll persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian
Subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands, and
Samoa.
American Indian or Alaskan NativeAll persons having origins in any of the original peoples of North America, and who maintain
cultural identification through tribal affiliation or community recognition.
AN EQUAL OPPORTUNITY EMPLOYER
For State Agency Use Only:
Applicant Number: ________________
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