AFFIRMATIVE ACTION FOR STATISTICAL USE ONLY The Northeast Illinois Railroad Corporation is an equal opportunity employer. To assist in the guarantee that this goal is accomplished, we need the following information from you. This information will not accompany your application, will not be used in the decision to hire or not to hire, nor will it in any way influence the NIRC’s determination of your qualifications for any position applied for. This information is strictly confidential. SOURCE OF REFERRAL 1. Name Community Address Organization Zip Newspaper Position(s) Applied for: NIRC Employee Walk In College Date of Birth (Optional) Other Circle the one number below which is appropriate. Female Male 1 0 WHITE, (not of Hispanic origin): A person having origins in any of the original people of Europe, North Africa or the Middle East. 3 2 BLACK, (not of Hispanic origin): A person having origins in any of the Black racial groups of Africa. 5 4 AMERICAN INDIAN OR ALASKAN NATIVE. A person having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition. 7 6 ASIAN OR PACIFIC ISLANDER. A person 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, Japan, Korea, the Philippine Islands and Samoa. 9 8 HISPANIC. A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish Culture or origin regardless of race. |
2. Should you want to be considered for protected class employment as a handicapped person, you may want to indicate the category which would qualify you by circling the appropriate number below. a.) Blindness/Visual Impairment f.) Nervous System Disorder b.) Deafness/Hearing Impairment g.) Respiratory Related Impairment c.) Orthopedic Impairment h.) Loss of Limbs d.) Cardiovascular Disorder i.) Other (Specify) e.) Mental Disorder 3. Veteran Yes No JOB CATEGORY: 4. ????? JOB GROUP: |
(Ord. CRB 84-44, passed 9-14-1984)