b5 *Required First Name * Middle Last Name * Primary Phone * Alternate Phone Best Time to be Reached Address * Address Line 2 City * State * Zip Code * Country E-mail * Voluntary Self-Identification Responses to the following questions are voluntary and are used only in compliance with government reporting guidelines. The Company has developed affirmative action programs to employ and advance in employment qualified individuals with disabilities and covered veterans. If you are an individual with a disability or a covered veteran and would like to be considered under our affirmative action programs, please complete the sections below. Providing this information is voluntary. Refusal to provide this information will not subject any individual to adverse treatment by the Company. If you choose not to self-identify at this time, you may do so at any time after your employment. Ethnicity I choose not to self-identify at this time Hispanic / Latino Asian American Indian / Alaskan Black / African-American Native Hawaiian / Other Pacific Islander White Non-Hispanic / Latino - Two or More Races Gender Female Male I choose not to self-identify at this time Military Status Not a Veteran Disabled Veteran Recently Separated Veteran Other Protected Veteran Armed Forces Service Medal Veteran I choose not to self-identify at this time If Necessary, Are You Willing to Relocate? * Yes No Maybe What is Your Most Recent Annual Salary? * What is Your Desired Hourly Rate? * What Date Would You Be Available to Start? Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20212022202320242025 Cover Letter Attach Your Resume * How Did You Hear About Us? Dice.com DAI Website Recruiter Referral LinkedIn Other
