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Equal Employment Affirmative Action Program

  1. Request for Applicant Data

    TO ALL APPLICANTS: The City of Burlington has an Equal Employment Affirmative Action Program in effect. Qualified applicants are considered in the hiring process without regard to race, creed, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, familial status, political affiliation or citizenship. This Program ensures affirmative action is taken to recruit minority, female and disabled individuals.

    PLEASE NOTE: Completion of this form is optional and your decision to complete this form is strictly voluntary. If you choose to complete this form, it will be placed in a separate, confidential file in the Human Resources office. Any information you provide will not in any way be used against you as it does not become a part of your application form and is not available for review while your employment is under consideration. If you choose to not complete this form, it will not affect, in any way, any opportunities for employment or benefits.

  2. PERSONAL DATA

  3. AFFIRMATIVE ACTION RELATED DATA

  4. Race/Ethnic Origin:

  5. Sex

  6. Are you a Vietnam Era Veteran (as defined below)?

    Definition: A person who served on active duty for more than 180 days, any part of which occurred between August 5, 1964 and May 7, 1975, and was discharged with other than a dishonorable discharge or was discharged or released from active duty for a service-connected disability.

  7. Are you a Disabled Veteran (as defined below)?

    Definition: A person entitled to disability compensation under regulations administered by the Department of Veterans Affairs for a disability rated at 30% or greater, or a person whose discharge or release from active duty was for a disability incurred or aggravated in the line of duty.

  8. Are you a person with a disability (as defined below)?

    Definition: A person who has a mental or physical impairment which substantially limits one or more major life activities or who has a record of such impairment, or is regarded as having such an impairment.

  9. Do you need accommodation?

  10. IOWA VETERANS PREFERENCE POINTS DATA

    Note: Veteran information listed above will also be considered in computing preference points.

  11. Are you a World War II Veteran (as defined below):

    Definition: A person who served on active duty at any time between December 7, 1941 and December 31, 1946 and was honorably discharged.

  12. Are you a Korean Conflict Veteran (as defined below):

    Definition: A person who served on active duty at any time between June 25, 1950 and January 31, 1955 and was honorably discharged.

  13. Are you a Persian Gulf Conflict Veteran (as defined below):

    Definition: A person who served on active duty at any time August 2, 1990 to present and was honorably discharged.

  14. Leave This Blank:

  15. This field is not part of the form submission.