APPLICANT EEO SURVEY
The Vermont Judiciary is an Equal Opportunity/Affirmative Action Employer. The information requested
below is gathered to comply with Federal record keeping regulations and Equal Employment
Opportunity/Affirmative Action requirements. You are not required to furnish this information; however,
your cooperation is strongly encouraged and appreciated. The information on this form is CONFIDENTIAL
and will be available only to authorized personnel for research and evaluation purposes. This page is
se
parated from your application prior to review and destroyed after data entry.
What is your gender?
□ Male □ Female
How do you describe yourself?
□ Black (not of Hispanic origin): Persons having origins in any of the Black racial groups of Africa
□ American Indian or Alaskan Native: Persons having origins in any of the original peoples of North
America, and who maintain cultural identification through tribal affiliation or community recognition
□ Asian or Pacific Islander: 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.
□ Hispanic: Persons of Mexican, Puerto Rican, Cuban, Central or South American or any other Spanish
culture or origin, regardless of race.
□ White: (not of Hispanic origin): Persons having origins in any of the original peoples of Europe, North
Africa or the Middle East.
VERMONT JUDICIAL BRANCH EMPLOYMENT APPLICATION
Please read the instructions below before completing this application
Part B
