R3 SSG EEO Voluntary Self-Identification Form

R3 SSG is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal state or local laws. R3 SSG IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, R3 SSG OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE.

Though all major browsers can be used to complete this form, we recommend using Google Chrome or Mozilla Firefox. If you experience a problem with the application form using a certain browser, please fill out the application using a different one.

We are subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, we invite our employees to voluntarily self-identify their race and ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify a specific individual.

If you have any questions regarding this form, please contact your Human Resources department or your supervisor.


** Indicates a required field.


Step 4 of 4


In order for R3 to review your application, you must complete all four steps of the application process.

After submitting the current form, you will receive a confirmation email.

Section 1: General Applicant Information

A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

If you answered no to the "Hispanic or Latino" field, please select the appropriate designation above.

Race/Ethnicity Descriptions

White (Not Hispanic or Latino) -- A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American (Not Hispanic or Latino) -- A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino -- A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Asian (Not Hispanic or Latino) -- A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

American Indian or Alaska Native (Not Hispanic or Latino) -- A person having origins in any of the original peoples of North or South America (including Central America), and who maintain tribal affiliations or community attachment.

Two or More Races (Not Hispanic or Latino) -- All persons who identify with more than one of the above five races.

Type your full name (First Middle Last) into the box.

Enter your email address to send the verification that we have received your employment application.

Step 4 of 4


In order for R3 to review your application, you must complete all four steps of the application process.

After submitting the current form, you will receive a confirmation email.

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