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Voluntary Applicant Information

To ensure equal employment opportunity we ask your voluntary cooperation in responding to the questions below. This information will be treated as confidential and will be available only to authorized personnel.

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* 1. Name (Last, First, Middle Initial)

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* 2. Date of Birth (mm/dd/yyyy)

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* 3. Recruitment Number (e.g. 2005-11-1234)

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* 4. What is your gender?

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* 5. What race or culture do you consider yourself? (Check all that apply)

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* 6. Have you ever been on active duty in the US Armed Forces?

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* 7. If yes, what dates?

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Date

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* 8. Are you a Vietnam era veteran?

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* 9. Are you a disabled veteran?

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* 10. Do you have a long-term physical, mental, or sensory impairment which substantially limits one or more major life activities? This is refering to impairment that is permanent in that is is seldom fully corrected by medical replacement, therapy or surgical means.

Thank you for completing this form. To qualify and receive veteran’s preference, you must attach a copy of the discharge, DD214 or NGB Form 22 with your application materials. If you have any questions please contact the DNR Recruitment Team at DNRrecruiting@dnr.wa.gov or (360) 902-1350.

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