City of Montrose
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The following information is being collected for our Equal Opportunity Employment program. This information will allow us to analyze who applies for jobs with the City and how they found out about the opening. This information will be separated from your application form and will not in any way be used in consideration of your application form. All information provided will be kept confidential. Refusal to provide this information will not subject you to any adverse treatment.


   I do not wish to provide the information below: (NOTE: Refusal to provide this information will NOT affect the status of your  application form.)

 Position Applied For:   Date:

 Name of Applicant (Please Print):  

 AGE:  14-17    18-20    21-29    30-39    40-49    50-59    60+  

Gender (Please check the appropriate category (ies).):

 GENDER:  Male    Female  

ETHNIC GROUP (Please check the apporiate category (ies).):

   WHITE - (Not of Hispanic origin) includes all persons having origins in any of the original people of Europe, North Africa, or Middle  East.
   BLACK - (Not of Hispanic origin) includes all persons having origins in any of the Black racial groups of Africa.
   HISPANIC - (includes all persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or  origin,  regardless of  race.
 Does not include persons of Portuguese culture or origin.
   ASIAN OR PACIFIC ISLANDERS - includes all persons having origins in any of the original peoples of the Far East, Southeast Asia,  the Indain  subcontinent, or the Pacific Islands.
   AMERICAN INDIAN OR ALASKAN NATIVE - includes all persons having origins in any of the original peoples of North America, and  who maintain  cultural identification through tribal affiliations or community recognition.

I HAVE LEARNED OF THIS OPENING THROUGH (Check any that apply):

   Newspaper Ad in:  Montrose Enterprise    Sentinel    Denver Post  
     Rock Mountain News    Daily Camera    Other  
   City of Montrose's Website  
   Notice in a professional magazine or journal:  Name of magazine/journal:
   Ad on City of Montrose bulletin board  
   College, university, or trade school:  Name of School:
   Placemenet Service:  Name of Service:
   Personal contact with:  Name/Title of Individual:
   City of Montrose Job Line (303) 438-6475  
   Other:  

THIS INFORMATION WILL BE SEPARATED FROM YOUR APPLICATION FORM.
THANK YOU FOR YOUR COOPERATION.

CITY OF MONTROSE HUMAN RESOURCES DEPARTMENT