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This survey is designed to help us determine if our recruiting efforts are reaching a representative cross section of the population of our community. The results will provide us with data needed for internal analysis and to satisfy our government reporting obligations. The information will be kept confidential. It will be kept separate from your personnel file and will not be made available to anyone making employment-related decisions. It will not affect your consideration for any position with the Company. We consider all applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, marital status, status with regard to public assistance, veteran status or membership in any other legally protected class. Although the completion of this survey is strictly voluntary, we will appreciate your assistance with our Affirmative Action Program by providing the information requested below.

A person is disabled if he or she has a physical or mental impairment which substantially limits one or more of such person's major life activities, has a record of such impairment, or is regarded as having such an impairment. "Disabled veteran" means a veteran who is entitled to compensation under laws administered by the Veterans Administration for disability rated at 30 percent or more, or a person who was discharged or released from active duty because of a service connected disability. "Veteran of the Vietnam Era" means a person who served active duty for more than 180 days, any part of which occurring between August 5, 1964 (February 28, 1961 if the veteran served in the Republic of Vietnam during this period) and May 7, 1975, and was not discharged or released dishonorably or was discharged or released for a service connected disability. "Other Eligible Veterans" means veterans who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized.

Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. Information you submit about your disability or veteran status will be kept confidential, except that (1) supervisors and managers may be informed regarding restrictions on the work or duties of individuals with disabilities, and regarding necessary accommodations; (2) first aid and safety personnel may be informed, when and to the extent appropriate, if the condition might require emergency treatment; and (3) government officials engaged in enforcing discrimination laws may be informed. The information provided will not be used in a manner inconsistent with section 503 of the Rehabilitation Act of 1973 and section 402 of the Vietnam Era Veterans Readjustment Assistance Act of 1974.

If you chose not to complete this form at this time, you may do so at any future date of your choice.

Thank you for your assistance.