Invitation Self Identify << United Labs, Inc.

United Laboratories, Inc. is committed to the provision of equal opportunity employment for all qualified persons in all job classifications in recruitment, selection and promotion without regard to race, color, religion, gender, national origin, age, disability, military status, veteran status or any other protected status. Completion of this form will assist us in complying with federal regulations and other applicable legal requirements. Submission of this information is voluntary and is not considered in employment decisions. This form will be kept separate from the employment application, and is considered confidential.

Date:	Position Applied For (You must apply for a current opening):

Applicant's Name: (First, Middle, Last)

Gender:	Race/Ethnicity:
Male Female	Hispanic or Latino White Black or African American Native Hawaiian or Other Pacific Islander Asian American Indian or Alaska Native Two or more races

Race/Ethnicity Classifications:

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Black or African American: A person having origins in any of the Black racial groups of Africa.

Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

Two or More Races: All persons who identify with more than one of the above five races.

Signature:		Date:

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