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EMPLOYMENT SURVEY

To print and send in a completed survey, please fill out the form below and click the Preview button to view the form in a new window. If all of the fields are filled out appropriately, select Print from your browser file menu to send the form to your printer. Clicking the Submit button will send your survey via email.

TO BE COMPLETED BY APPLICANT

Mail the completed form to:
ROAD COMMISSION FOR OAKLAND COUNTY
31001 LAHSER
BEVERLY HILLS, MI 48025

Or fax to (248) 645-5792.

All job applicants of the Road Commission for Oakland County are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or disability. As an employer/government contractor, we comply with government regulations and affirmative action responsibilities.

To help us comply with government record keeping, reporting and other legal requirements, we ask that you please fill out the Applicant Data Record. The information requested on this form will not be used for decisions related to hiring, placement, or any other decision related to terms and conditions of employment. Refusal to provide this information will not subject you to adverse treatment. This data is solely for periodic government reporting and is kept in a Confidential File separate from the Application for Employment. We appreciate your cooperation.

Last Name:

First Name:

Middle Initial:

Social Security Number:

- -

Birth Date:

Date:

Address:

Street:

City:

State:

Zip Code:

Race:

	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.
	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.
	American Indian or Alaska 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 maintains tribal affiliation or community attachment.
	Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races.

Sex:

Male Female

Type of position applied for:

Highest Level of Education

Not High School Graduate	High School Graduate	Associate's Degree
Bachelor's Degree	Doctorate	Master's Degree

Check if any of the following are applicable:
* DISABLED - "DISABLED INDIVIDUAL" MEANS ANY PERSON WHO:

	Person with a Disability: A person who has a physical or mental impairment which substantially limits one or more of his/her major life activities; has a record of such impairment; or is regarded as having such an impairment
	Vietnam Era Veteran
	Disabled Veteran

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