Applicant Demographics Survey – Jorgenson Construction

Voluntary Disclosure

As an affirmative action employer, we must monitor our equal employment opportunity and affirmative action program, and report these results to government agencies. If you choose not to provide some or all of this information, you will not be subject to any negative or adverse treatment. The information you provide is completely voluntary and will only be used to monitor our compliance with equal opportunity laws and regulations.* When we receive this form, we will immediately place it in a confidential file separate from your application. If you wish, you may download this form and mail or fax it to us separately.

For printed submissions, mail to:
Jorgenson Construction
ATTN: Aaron Weed
9255 East River Road NW
Minneapolis, MN 55433
F: 763-784-1583

Equal Opportunity – Applicant Demographics

As an affirmative action employer, we must monitor our equal employment opportunity and affirmative action program, and report these results to government agencies. Your participation is optional but much appreciated.

Step 1 of 2

Race/Ethnicity (Select all that apply)*
- American Indian or Alaskan Native: A person having origins in any of the original peoples of North, South or Central Americas, and who maintains tribal affiliation or community attachment.
- Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia or Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
- Black or African American: A person having origins in any of the black racial groups of Africa.
- Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South, Central American or other Spanish culture or origin, regardless of race.
- Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
- White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
- Prefer not to answer