Optional Data Collected For Statistical Purposes

Phone: 757-539-2100 | Fax: 757-539-5184
530 East Pinner St. | Suffolk, VA 23434
SuffolkrHA.org
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Pursuant to federal regulations, we collect responses to the questions below for record keeping purposes. This information will not be kept with your application for employment. Federal law prohibits unlawful discrimination on that basis of race, color, sex, national origin, religion or disability.

Highest level of education you have completed:

Racial or ethnic group with which you identify:

Sex:

Date of Birth:

Position Applied For:

*Required Fields