MCDHH Applicant Demographics

Sharing your demographic information will allow us to see if we are achieving our goal to have a workplace that reflects the diversity of the populations we serve which contributes to our ability to provide the highest quality services.

We would greatly appreciate you completing this anonymous and confidential survey, but it is not a requirement for you to be considered for this opportunity.

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1. Gender: (Please check all that apply.)

Male

Female

Non-binary

Transgender

Prefer Not to Answer

Preferred gender identity (please specify):

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2. Age: (Please check the age range that applies.)

16-24

25-34

35-44

45-54

55-64

65 or over

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3. Race and Ethnicity: (Please check all that apply.)

African American or Black

Asian or Pacific Islander

Caucasian or White

Latinx or Hispanic

Native American or American Indian

Multiracial or Biracial

Prefer Not to Answer

Other (please specify):

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4. Sexual Orientation: Which of the following best represents how you think of yourself?

Heterosexual/Straight

Homosexual/Gay/Lesbian

Bisexual

I'm not sure about my sexual orientation.

I'm not sure what this question means.

Prefer Not to Answer

I prefer to self-identify (please specify):

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5. Veteran Status: Please check the box below if you are a veteran.

“Veteran” shall mean (1) any person, (a) whose last discharge or release from his wartime service as defined herein, was under honorable conditions and who (b) served in the army, navy, marine corps, coast guard, or air force of the United States, or on full time national guard duty under Titles 10 or 32 of the United States Code or under sections 38, 40 and 41 of chapter 33 for not less than 90 days active service, at least 1 day of which was for wartime service; provided, however, than any person who so served in wartime and was awarded a service-connected disability or a Purple Heart, or who died in such service under conditions other than dishonorable, shall be deemed to be a veteran notwithstanding his failure to complete 90 days of active service; (2) a member of the American Merchant Marine who served in armed conflict between December 7, 1941 and December 31, 1946, and who has received honorable discharges from the United States Coast Guard, Army, or Navy; (3) any person (a) whose last discharge from active service was under honorable conditions, and who (b) served in the army, navy, marine corps, coast guard, or air force of the United States for not less than 180 days active service; provided, however, that any person who so served and was awarded a service-connected disability or who died in such service under conditions other than dishonorable, shall be deemed to be a veteran notwithstanding his failure to complete 180 days of active service.

I am a veteran.

I'm not a veteran.

Prefer Not to Answer.

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6. Disability Status: (Please check the box below if you have disability.)

I have a disability.

I don't have a disability.

Prefer Not to Answer.

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7. Deaf or Hard of Hearing: Which of the following best represents how you think of yourself?

Deaf

Hard of Hearing

DeafBlind

Late-Deafened

CODA

Hearing

Prefer Not to Answer

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8. Heritage Signer: (Please check all that apply regarding being a heritage signer.)

Yourself, Deaf

Deaf parent

Both Deaf parent

Have immediate family member who’s Deaf

I'm not a heritage signer.

Prefer Not to Answer

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9. Geographic Experiences: Please tell us about where you have lived.

I lived in Urban area for at least 5 years.

I lived in a Suburban area for a least 5 years.

I lived in a Rural area for at least 5 years.

MCDHH Applicant Demographics

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* 1. Gender: (Please check all that apply.)

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* 2. Age: (Please check the age range that applies.)

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* 3. Race and Ethnicity: (Please check all that apply.)

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* 4. Sexual Orientation: Which of the following best represents how you think of yourself?

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* 6. Disability Status: (Please check the box below if you have disability.)

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* 7. Deaf or Hard of Hearing: Which of the following best represents how you think of yourself?

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* 8. Heritage Signer: (Please check all that apply regarding being a heritage signer.)

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* 9. Geographic Experiences: Please tell us about where you have lived.

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* 10. Please share your country of birth:

1. Gender: (Please check all that apply.)

2. Age: (Please check the age range that applies.)

3. Race and Ethnicity: (Please check all that apply.)

4. Sexual Orientation: Which of the following best represents how you think of yourself?

6. Disability Status: (Please check the box below if you have disability.)

7. Deaf or Hard of Hearing: Which of the following best represents how you think of yourself?

8. Heritage Signer: (Please check all that apply regarding being a heritage signer.)

9. Geographic Experiences: Please tell us about where you have lived.

10. Please share your country of birth: