Holland America Line
Westours Inc.
EEO/AA                                SELF-IDENTIFICATION OF MINORITIES,
                                    VETERAN STATUS, OR DISABILITY STATUS

Holland America Line Westours Inc. is an Equal Employment/Affirmative 
Action Employer and is required by the Department of Labor to provide 
statistical information on our applicants. We would appreciate your 
assistance in meeting these requirements by voluntarily providing the 
following information. This information will be kept separate from 
the application form unless you are an applicant eligible for 
consideration under Affirmative Action and specifically request that 
your application be processed through our Affirmative Action Program 
as well as regular recruiting processes. This information will not be 
used in a discriminatory manner.

Name:____________________________________________ Date:_______________

Address:_______________________________ State: ________ Zip: _________

SSN (for identification purposes only)________________________________

Position applied for:_________________________________________________

Referral Source:______________________________________________________
......................................................................

Gender: ___Male  ___Female

Please mark one of the following categories 
       (defined by governmental terms).

___White-     or not covered below
___Black-     All persons having origins in any Black racial groups of 
              Africa.
___Hispanic-  All persons of Mexican, Puerto Rican, Cuban, Central or 
              South American, or other Spanish culture, regardless of
              race.
___Asian-     All persons having origins in any of the original peoples 
              of the Far East, Southeast Asian, the Indian Subcontinent, 
              or the Pacific Islands. This area includes, for example, 
              China, Japan, Korea, the Philippine Islands and Samoa.
___Native     All persons having origins in any of the original peoples
   American-  of North America, and who maintain cultural identifica-
              tion through tribal affiliation or community recognition. 
              Meets Bureau of Indian Affairs definition standards.
......................................................................

Presence of a work restricting disability _____

Special Accommodations, methods, or procedures which might qualify me
for positions that I might not otherwise be able to perform.__________

______________________________________________________________________

......................................................................

Vietnam Era Veteran: ___Yes ___No (Served between 08/05/64 & 05/07/75)

Disabled Veteran:    ___Yes ___No (Receives 30% military disability)