Applicant Survey

Barber Manufacturing Company, Inc. is an equal opportunity employer and does not discriminate in firing or employment on the basis of race, color, religion, sex, national origin, age, disability or any other basis prohibited by federal, state or local law. No question on this form is intended to secure information to be used for such discrimination.

The company is required by federal regulation to report information as requested below. Your contribution of this information is completely voluntary and refusal to complete this form will not affect any hiring or employment decisions. The information you provide is strictly confidential and will be maintained separate from your personnel file. You may inform us of your desire to benefit under the program at this time and/or any time in the future.

INDICATE THE APPROPRIATE RACE/ETHNIC GROUP: White (not Hispanic or Latino) – having origins in any of the original peoples of Europe, the Middle East or North Africa
Black or African-American (not Hispanic or Latino) – having origins in any of the black racial groups of Africa
Hispanic or Latino – of Cuban, Mexican, Puerto Rican, South or Central American descent, or other Spanish culture or origin regardless of race
Native Hawaiian or other Pacific Islander (not Hispanic or Latino) – having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands
American Indian or Alaskan Native (not Hispanic or Latino) – having origins in the original peoples of North or South America (including Central America), and maintaining tribal affiliations or community involvement
Asian (not Hispanic or Latino) – having origins in the Far East, Southeast Asia or the Indian Subcontinent, including Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam
Two or more races (not Hispanic or Latino) – anyone who identifies with more than one of the above five races
Other