Pre-Employment Voluntary Questionnaire | Samson ...A Premier Exploration And Production Company

PRE-EMPLOYMENT VOLUNTARY QUESTIONNAIRE

The federal government under Executive Order 11246 requires the corporation to report gender and race/ethnicity of applicants for employment. Submission of information is voluntary, and failure to provide it will not subject you to any adverse treatment. Your cooperation is appreciated.

Samson is an equal opportunity corporation and does not discriminate on the basis of race, color, sex, sexual orientation, national origin, religion, age, disability or veteran status in admission or access to, or treatment or employment in, its programs and activities.

Name (Required)		Position Applying For (Required)
INDICATE GENDER

INDICATE RACE/ETHNICITY
Please check all that apply.
	*Hispanic or Latino:* - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
	*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.
	*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 and South America (including Central America), and who maintains tribal affiliation or community attachment.
	*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.

	I do not wish to complete this form (Name and position applying for are required.)