BILL ANSKIS COMPANY, INC.

It is the policy of this company to assure that applicants are employed, and that employees are treated during employment without regard to their race, religion, sex, color, national origin, age, or disability. Such action shall include: Employment, upgrading, demoting, or transfer; recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship, pre-apprenticeship, and/or on the job training.

Please list three professional references

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Bill Anskis Company, Inc. is an equal Opportunity Employer. As required by law, we must record certain information to be made part of our Affirmative Action Program. Applicants for employment are also invited to participate in the Affirmative Action Program by reporting their status as handicapped, disabled veteran, veteran of the Vietnam era or other minority. In extending this invitation you are also advised that: (a) workers (applicants) are under no obligation to respond, but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for the necessary information to include in our Affirmative Action Program. We are a company that values diversity. We actively encourage women and minorities to apply. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment.

Applicant Information

Please Check All That Apply (see below for definitions)

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

A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

A person having origins in any of the black racial groups of Africa.

A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

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.

A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

All persons who identify with more than one of the above five races.

Defined as a veteran who (a) served on active duty in the Republic of Vietnam between February 28, 1961 and May 7, 1975, or (b) served on active duty for a period of more than 180 days, any part of which occurred between August 5, 1964 and May 7, 1975, and was discharged or released there from with other than dishonorable discharge, or (c) was discharged or released from active duty for a service-connected disability if any parts of his or her active duty was performed between August 5, 1964 and May 7, 1975.

Defined as any veteran who served in a “war” declared by Congress, in a campaign or on an expedition for which a campaign badge, service medal, or an expeditionary medal has been awarded.