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CITY OF NORTH OLMSTED <br />VOLUNTARY DATA SHEET <br />PERIODIC REPORTS ARE MADE TO THE STATE OF OHIO WITH RESPECT TO <br />AFFIRMATIVE ACTION PROGRESS. WE ASK THAT YOU ASSIST WITH OUR <br />EFFORTS TO REPORT INFORMATION AS ACCURATELY AS POSSIBLE. THE <br />VOLUNTARY INFORMATION YOU PROVIDE WILL BE SUBMITTED TO THE <br />AFFIRMATIVE ACTION COORDINATOR AND WILL NOT HAVE ANY BEARING <br />ON YOUR TEST RESULTS. <br />AGAIN THIS INFORMATION IS VOLUNTARY: <br />MALE [ ] FEMALE[ ] <br />(A) CAUCASIAN [ ] (B) AFRICAN AMERICAN [ ] C) HISPANIC [ ] <br />(D) AMERICAN INDIAN OR ALASKAN NATIVES [ ] <br />(E) ASIANS OR PACIFIC ISLANDERS [ ] <br />(F) OTHER: <br />PLEASE SPECIFY <br />(A.) White (not of Hispanic origins): All persons having origins in any of the original peoples <br />of Europe, North Africa or the Middle East. <br />(B.) Black (not of Hispanic origins): All persons having origins in any of the Black racial of <br />Africa. <br />(C.) Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American or <br />other Spanish culture or origin, regardless of race. <br />(D.) American Indian or Alaskan Native: All persons having origins in any or the original <br />peoples of North America, and who maintain cultural identification through affiliation or <br />community recognition. <br />(E.) Asian or Pacific Islander: All persons having origins in any of the original peoples of Far <br />East, Southeast Asia, the Indian Subcontinent, of the Pacific Islands. The area includes <br />for example, China, Japan, Korea, the Philippine Islands and Samoa. <br />POSITION APPLYING FOR: FIREFIGHTER/PARAMEDIC <br />DATE TEST IS GIVEN (DATE OF TEST HERE) <br />THIS PAGE MAY BE RETURNED <br />AT THE DISCRETION OF THE APPLICANT <br />12 <br />