CHISOS MOUNTAINS LODGE
At Big Bend National Park

Voluntary Affirmative action Information Form - Applicants
(Confidential: For Statistical Use Only)

In an effort to implement our voluntary government affirmative action program recordkeeping and reporting requirements, we ask that you complete this data survey. Your cooperation is appreciated. Providing this information is STRICTLY VOLUNTARY. Failture to provide it will not subject you to any negative personnel action. Information provided wiill be kept confidential in accordance with applicable regulations.

Name     Last     First

Date   

Position   

Referral Source     Identify

Gender    Male      Female   
  
Race / Ethnicity (Please check one box only)

White     Hispanic or Latino     American Indian/Alaskan Native
Black or African American       Asian
Native Hawaiian or Other Pacific Islander     Two or more races

Hispanic or Latino - A person of Cuban, Mexican, South or Central =American, of other Spanish culture or origin regardless of race.

White (not Hispanic or Latino) - A person having origins in any of the poriginal 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 Hawaiaan 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 India 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 people of North and South America (including Central America) and who maintain tribal affiliation or community attachement.

Two or More Races (not Hispanic or Latino) - All persons who identify with more than one of the races of: White, Black or African American, Native Hawaiian or Other Pacific Islander, Asian or American Indian or Alaska Native


Rev 01/08