Voluntary Self-Identification Form

  • The following statistical information is used by community Medical Center only for compliance with federals laws. To comply with these laws, we invite you to voluntarily self-identify your race or ethnicity. Submission of this information obtained is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and separate from personnel files. It may only¬† be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those requiring information to be summarized and reported to the federal government for civil rights enforcement.

  • Max. file size: 16 MB.
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