Secretary of State’s Internship
EEO DATA FORM
The information requested is optional and is being collected for the purpose of reporting to Federal and Equal Employment
Opportunity Agencies and will not be considered as part of the application for employment. It will be separated from the
application.
1. Semester / Year
3. Last Name
(Type or Print) First Middle
4. Address
City
State
ZIP Code
5. Home Phone
( )
6. Work Phone
( )
7. Sex
M-Male
F- Female
8. Birth Date 9. Ethnic Origin (Check mark preferred)
W-White B-Black H-Hispanic P-Islander
Asian/Pac
I-Alaskan
Am.Ind/
O-Other
10. How did you find out about this internship?
01 - Other State Employee
02 - Job Fair
03 - Professional Publication
04 - Recruitment Poster
05 - Television
06 - Newspaper
Name of Newspaper
07 - College/University Career Day
08 - Human Resource/Personnel Office
09 - Radio
10 - Agency Web Site - Internet
11 - Texas Workforce Comm./
Hire Texas
12 - Other (specify):
X
Intern Signature Date
White (Not of Hispanic origin) – All persons having origins in any of the original peoples of Europe, North Africa, or the Middle
East.
Black (Not of Hispanic origin) – All persons having origins in any of the Black racial groups of Africa.
Hispanic – All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless
of race.
Asian or Pacific Islander – All persons 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, India, Japan, Korea, the Philippine Islands, and
Samoa.
American Indian or Alaskan Native – All persons having origins in any of the original peoples of North America, and who
maintain cultural identification through tribal affiliation or community recognition.
AN EQUAL OPPORTUNITY EMPLOYER
