GF – Employment Questionnaire – Fargo Glass & Paint Co.

Part 2 of 2

This Employment Questionnaire is voluntary. By providing this information, you assist Fargo Glass & Paint Company in meeting federal reporting requirements. The information provided on this form is confidential and is not used as part of the selection process.

Name (Optional)

Date

Date of Birth

Position applied for

How did you hear of this opening?

Other please list

Race or Ethnic Identity

American Indian
Asian
Black or African American
Hispanic (White Race Only)
Hispanic (All Other Races)
Native Hawaiian or Pacific Islander
White
Multi-Racial (Please List Below)

Multi-Racial List

Gender

Male
Female

Have you ever been on active duty in the U.S. Armed Forces?

Yes
No

Please list dates and military branch

Please select if applicable

Vietnam Era Veteran
Other Eligible Veteran

I do not wish to self-identify