CITY OF ATLANTIC BEACH
OPTIONAL
EEO SURVEY

Completion of this form is OPTIONAL. The following information will be used for Equal Employment Statistical information and identification purposes only. This form will be detached and not processed/provided with application form.

It would be helpful if you provided the following information.

Name:

Position Applied for:

Ethnic Background:

White Hispanic Black

Asian/Pacific Islander American Indian/Alaskan Native Other (Specify)

Gender:

Male

Female

Date of Birth:

Veteran

Yes

No

Marital Status:

Married Single

Divorced

Do you have a disabling or handicapping condition?

Yes

No

REFERRAL SOURCE

(Please indicate how you became aware of this job)

Florida Times Union Newspaper Shorelines Newspaper Beaches Leader Newspaper City of Atlantic Beach Web Page

Atlantic Beach City Employee Walk In Other