EQUAL EMPLOYMENT OPPORTUNITY SURVEY
TO ALL APPLICANTS:
The Town of Woodstock, Virginia is an equal opportunity employer and values diversity. We are requesting
that you provide us with the information indicated below. This information is kept for statistical reporting
only and is treated in a highly confidential manner. It will not be used by or shared with the selection
committee, and it will be maintained separately from your application file. Your cooperation by providing
this information on a strictly
basis is greatly appreciated. Refusal to provide this information will
have no bearing on your application and will not subject you to any adverse treatment.
Date: _______________________ Name: ___________________________________________
Position applying for: ____________________________________________________________
Gender: Male Female
Ethnicity (check only one):
Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or
other Spanish culture or origin regardless of race.
White (not Hispanic or Latino) - A person having origins in any of the original peoples of Europe,
the Middle East or North Africa.
Black or African American (not Hispanic or Latino) – A person having origins in any of the black
racial groups of Africa.
American Indian or Alaskan Native (not Hispanic or Latino) – A person having origins in any of the
original peoples of North and South America (including Central America) and who maintain tribal
affiliation or community attachment.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) – A person having origins in any
of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.
Asian (Not Hispanic or Latino) - 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, India,
Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
Two or More Races (Not Hispanic or Latino) – All persons who identify with more than one of the
above five races.