Gravity Survey – LaForge and Budd Construction Co., Inc.

BUILDING SATISFIED CLIENTS SINCE 1960

LaforgeBudd Survey

Thank you for completing the employment form, we have received it and will look forward to reviewing it shortly. Please complete the following employment survey for our records.

Part 2: APPLICANT DATA SURVEY CONFIDENTIAL

   (THIS FORM IS NOT TO BE PLACED WITH THE EMPLOYMENT APPLICATION WHEN RETURNED. THIS FORM SHALL BE KEPT IN SEPARATE LOCKED FILES AND SHALL BE UNAVAILABLE TO THE INTERVIEWERS) Qualified applicants 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 handicap. As an equal opportunity/affirmative action employer, we comply with government regulations and affirmative action responsibilities.
   This information is requested to assist our affirmative action efforts. This information will be treated as confidential. You are not required to furnish this information, although your doing so will be helpful in assembling data. Failure to provide this information will not jeopordize or adversely affect any consideration you may receive for employment.
    In order to help us comply with government record keeping, reporting and other legal requirements, please fill out the data recordbelow (this data will be kept in a confidential file).

Name

Position Applied For

Date

Sex: Male or Female?

Under or over 40?

Veteran's Status?

Are you: Special Qualified Disabled: Vietnam Veteran Era Served between 8/05/64 to 5/07/75: Or Veteran (Eligible for Benefits)

Race or Ethnic Group?

Are you: White: Black: Hispanic: Asian or Pacific Islander: American Indian or Alaska Native?

Referral Source?

Kansas Job Service Center: Relative: Friend: Employee: Newspaper Ad: School, College or Vocational Training Institute: Other (Specify)

APPLICANT CHARACTERISTIC SURVEY

To be detached by Company upon receipt This survey will be used only for equal opportunity review and statistical purposes in conjunction with remedial action obligations or voluntary remedial action efforts. You are not required to furnish the information on this form. Doing so will be helpful in assembling data, but refusal to do so will in no way affect you as an individual applicant and information provided will be kept confidential under 28.C.F.R.§42.513(d).

County of Residence

State of Residence

Date of Birth

Sex: Male or Female?

Highest Level of Education?

0-8 years: High School Graduate/GED: Post High School (vocational or business) College (less than BA or BS): 9-12 years: Ba, BS or similar degree: Other (Specify)

Race or Ethnic Group:

Are you: White: Black: Hispanic: Asian or Pacific Islander: American Indian or Alaska Native?

Referral Source:

Kansan Job Service Center: Advertisement: Other

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LaForge and Budd Construction Company

2020 N 21st St,

Parsons, KS 67357

(620) 421-4470

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