Maine Employment Application Form – Fill Out and Use This PDF

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1. I have read the paragraph above and do not

RACIAL/ETHNIC DEFINITIONS

wish to provide the information.

0. WHITE (not of Hispanic Origin): All persons having origins in any of the

-

-

2.

Enter your date of birth

original peoples of Europe, North Africa, or the Middle East.

1.

BLACK (not Hispanic Origin): All persons having origins in any of the Black

(month) (day)

(year)

racial groups of Africa.

2.

HISPANIC: All persons of Mexican, Puerto Rican, Cuban, Central or South

3. Enter your racial/ethnic group code number

American, or other Spanish culture or origin, regardless of race.

(refer to definitions at left)

3. ASIAN OR PACIFIC ISLANDERS: All persons having origins in any of the

original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the

Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine

Islands, and Samoa.

4. AMERICAN INDIAN OR ALASKAN NATIVE: All persons having origins in

any

of the original peoples of North America, and who maintain cultural

4.

What is your sex?

A. Female

B. Male

identification through tribal affiliation or community recognition.

6. OTHER

DEFINITIONS OF VETERANS SUBJECT TO EEO/AFFIRMATIVE

PLEASE PLACE AN X IN ALL BOXES WHICH APPLY TO YOU (refer

ACTION REGULATIONS:

to definitions at left)

(The requirements are different from State Veterans Preference)

VIETNAM ERA VETERAN: One who served on active duty for more than 90 days,

any part of which occurred between August 5, 1964 and July 7, 1975 and was

discharged or released other than a dishonorable discharge, or was discharged or

released from active duty for a service-connected disability if any part of such active

5.

Vietnam Era Veteran

duty was performed between August 5, 1964 and July 7, 1975.

DISABLED VETERAN: A person entitled to disability compensation under laws

6.

Disabled Veteran

administered by the Veterans Administration for a disability rated at 30 per cent or

more, or a person whose release from active duty was for a disability incurred or

aggravated in the line of duty.

DEFINITION FOR DISABILITY

PLEASE PLACE AN X IN ALL BOXES WHICH APPLY TO YOU (refer

to definitions at left)

Any person who has a physical or mental impairment which substantially limits one

or more of such person’s major life activities, has a record of such impairment, or is

regarded as having such impairment has a disability under the Americans With

Disabilities Act. Major life activities include: walking, seeing, hearing, learning,

7.

Have a disability as defined

self-care, speaking, lifting, reaching, thinking performing manual tasks, breathing,

working and interacting with others.

8. Interview accommodations may be necessary

due to a disability