Version 2018-04-10 Page 5 of 5
EQUAL EMPLOYMENT OPPORTUNITY - VOLUNTARY SURVEY
To comply with the U.S. Equal Employment Opportunity Commission and California Fair Employment and Housing requirements, Santa
Barbara MTD (SBMTD) is asking all applicants to provide the following information. Data collected will be used only for statistical
purposes to measure the effectiveness of our recruitment efforts.
SBMTD does not discriminate on the basis of race, color, creed, ancestry, national origin, gender, marital status, sexual orientation, religion,
age, veteran status or disability in the provision of services or employment. This portion of the application will be detached, and the
information will not be used to make any employment decision that affects you.
Decline to state
40 or over
Decline to state
DO YOU CONSIDER YOUR ETHNIC BACKGROUND TO BE HISPANIC OR LATINO?
Hispanic or Latino means a person of Cuban, Mexican, Puerto Rican, South or Central American or other
YES, I am Hispanic or Latino.
NO, I am not Hispanic or Latino.
STARTING WITH THE 2000 U.S. CENSUS, THE CLASSIFICATION OF HISPANIC/LATINO WAS CHANGED FROM A
RACIAL GROUP TO AN ETHNICITY GROUP. WHETHER OR NOT YOU CHECKED “YES, I AM HISPANIC OR LATINO”
ABOVE, YOU MUST ALSO CHECK A CATEGORY OF RACIAL GROUP BELOW.
WHAT RACIAL GROUP DO YOU CONSIDER TO BE YOUR MOST PREDOMINANT? (CHECK ONLY ONE)
American Indian or Alaska Native - A person having origins in any of the original peoples of North and
South America, including Central America, and who maintains tribal affiliation or community attachment.
Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia or the
Indian subcontinent, including for example, Cambodia, China, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand and Vietnam.
☐ Black or African American - A person having origins in any of the Black racial groups of Africa.
Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of
Hawaii, Guam, Samoa, or other Pacific Islands.
Caucasian (White) - A person having origins in any of the original peoples of Europe, the Middle East or
North Africa. If your origins are from Spain, you should check “Caucasian.”
☐ American Indian or Alaska Native & Black
☐ American Indian or Alaska Native & White
Asian & Black
Black & White
☐ Please name the racial group(s)
PLEASE TELL US HOW YOU HEARD ABOUT THIS JOB OPENING?
Job bulletin posting (flyer)
Employee Referral (name):
Newspaper: VC Star, Santa Maria Times
EDD Employment Development Department / Jobs Center
Advertisement seen on bus
Facebook / Twitter / Instagram (or other social media)
Website: www. craigslist.com
TV / Radio
Another Website (name)