Wayside Technology Group - AAP Identification Form

Wayside Technology Group, Inc. is an Equal Opportunity Employer. As required by law,we must record certain information to be made a part of our Affirmative Action Program.

Applicants for employment are also invited to participate in the Affirmative Action Program by reporting their status as handicapped, disabled veteran, veteran of the Vietnam era or other minority. In extending this invitation you are also advised that: (a) workers (applicants) are under no obligation to respond, but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for the necessary information to include in our Affirmative Action Program. We are a company that values diversity. We actively encourage women and minorities to apply. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment.

Please complete the information requested below. Thank you for your cooperation.

Section 1 : General Applicant Information
Name*	Date*

Position Applied For*

Section 1 : Please check all that apply

Race or Ethnic Identity

Gender

**Veteran Status

Hispanic or Latino
White (not Hispanic or Latino)
Black or African American (not Hispanic or Latino)
Native Hawaiian or Pacific Islander (not Hispanic or Latino)
Asian (not Hispanic or Latino)
American Indian or Alaskan Native (not Hispanic or Latino)
Two or More Races (not Hispanic or Latino)

Male
Female

Vietnam Era Veteran
Special Disabled Veteran
Other Eligible Veteran
Non Veteran

**Other Status

Individual With Disabilities

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