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Voluntary Equal Employment Opportunity Survey
Your cooperation by providing the survey information below on a VOLUNTARY BASIS is greatly appreciated. The information obtained is kept strictly confidential and may be used only in accordance with provisions of applicable laws, executive orders, and regulations, including those that require the information to be reported to the federal government for civil rights enforcement. When reported, data will not identify a specific individual. This information helps H.O. Wolding, Inc. (H.O.W) comply with mandatory government recordkeeping and reporting requirements. Submission of this information is voluntary and is not required as a condition of employment, nor will it affect any decisions regarding your employment.
RACE AND ETHNIC IDENTIFICATION (www.eeoc.gov) Race and ethnic designations as used by the Equal Employment Opport unity Commission do not denote scientific definitions of anthropological origins. Definitions of the race and ethnicity categories are as follows:
| Hispanic or Latino: Person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race. | Yes No |
| White (Not Hispanic or Latino): Person with origins in any of the original peoples of Europe, the Middle East or North Africa. | Yes No |
| Black or African American (Not Hispanic or Latino): Person having origins in any of the black racial groups of Africa. | Yes No |
| Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino): Person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands. | Yes No |
| Asian (Not Hispanic or Latino): Person having origins in any of the original peoples of the Far Eastern, Southeast Asia or the Indian Subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Island, Thailand and Vietnam. | Yes No |
| American Indian or Alaska Native (Not Hispanic or Latino): Person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. | Yes No |
| Two or More Races (Not Hispanic or Latino): All persons who identify with more than one of the above five races. | Yes No |
DISCLOSURE AND RELEASE AUTHORIZATION
Carefully read and authorize with applicant signature. Please print name, sign and date below before faxing. If you have any questions regarding this form, please call H.O. Wolding, Inc. for clarification.
In connection with my application for employment with H.O. Wolding Inc., I understand that a consumer report which may contain public record information, may be requested from DAC Services, Tulsa, Oklahoma and/or other driving record sources. These reports may include the following information: names and dates of previous employers, reason for termination of employment, work experience, accident, etc. I further understand that such reports may contain public record information concerning my driving record, workers' compensation claims, credit, and bankruptcy proceedings, criminal records, etc., from DAC concerning previous driving record requests made by others from such state agencies and state provided driving record.
I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAC AND/OR OTHER DRIVING RECORD SOURCES TO FURNISH THE ABOVE MENTIONED INFORMATION.
I have the right to make a request to DAC and or other driving sources, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which DAC and/or other driving sources, has previously furnished with in the two-year period preceding my request. I hereby consent to H.O. Wolding, Inc. obtaining the above information from DAC, and I agree that such information, which DAC and/or other driving record sources have to obtain, and my employment history with H.O. Wolding Inc., if I am hired, will be supplied by DAC to other companies, which subscribe to DAC Services.
I hereby authorize procurement of consumer report(s). If hired, this authorization information shall remain on file and shall serve as an ongoing authorization for H.O. Wolding Inc. to procure consumer reports at any time during my employment period.
I hereby authorize, without liability, any person/organization whose name I provided as a reference, or by whom I was previously employed or contracted, to furnish H.O.W any information regarding my performance, character, habits, ability, financial responsibility, job performance or other work-related characteristics, reasons for leaving my employment/lease and all information concerning my employment. I hereby release all such persons and organizations from any claims for damages of any kind, which may befall me by reasons of furnishing such information.
I attest that this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge. Any false, misleading or incomplete statement of the information requested in this application and any supplemental material submitted shall be sufficient grounds for disqualification of this application or termination from employment, if this application results in employment.
I understand and agree that this application for employment in no way obligates H.O. Wolding, Inc. to employ this applicant. I also understand and agree that if I am hired, I am required to comply with all company policies, State and Federal regulations as they may apply.
Furthermore, I understand and agree that if hired, it will be considered "At Will" and H.O. Wolding, Inc. may suspend or terminate my employment without reason or cause at any time.
I attest I have read and understand the terms of this DISCLOSURE AND RELEASE AUTHORIZATION by placing my name at the bottom of said document and hereby authorize H.O.W and its employees, agents, and affiliates to obtain the information authorized in this DISCLOSURE AND RELEASE AUTHORIZATION document. If hired, this authorization form shall remain on file and serve as ongoing authorization for H.O. Wolding, Inc. to procure consumer reports anytime during my employment period.
