Patients & Families
Health Sense Privacy Statement
Why Choose Health Sense
Equal Employment Opportunity (EEO) Self-Identification Form
Qualified applicants are considered for employment without regard to race, color, religion, sex, national origin, age, disability, or membership in any other protected class.
Health Sense is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, Health Sense invites applicants to voluntarily self-identify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may 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.
This form will be kept in a confidential file separate from your application for employment.
Position applied for:
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.
Native Hawaiian or Other Pacific Islander (not Hispanic or Latino):
A person having origins in any of the 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, e.g., 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.
Two or More Races (not Hispanic or Latino):
A person who identifies with more than one of the above races.
Proudly powered by