Skip to Main Content
EMPLOYMENT OPPORTUNITIES
DEI STATEMENT
Contact Us
Menu
Alcohol & Substance Abuse
Overdose Information
Addiction Medicine Clinic
Mental Health
Gambling
Community Mental Health
Servicios Latinos
Success Stories
About Us
"
*
" indicates required fields
Name
*
First
Last
Date
MM slash DD slash YYYY
EQUAL EMPLOYMENT OPPORTUNITY
This information will only be used to assist us in fulfilling Equal Employment Opportunity/Affirmative Action reporting and requirements to determine race, gender, disability, and veteran status of applicants. Covered employers under EEOC must invite employees to self-identify gender and race for EEO-1 reporting. Submission of this information is completely voluntary. This information will NOT be considered in the hiring process, or the terms or conditions of your employment, nor will this information subject you to any adverse treatment. This information will not be kept in any individual’s personnel file and will not be viewed by any hiring managers. Notice of Accommodation: Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities.
Race/Ethnicity
Please note that for tracking purposes only one race/ethnic group can be listed. If you are of more than one group, please check the box for the group with which you most closely identify.
Hispanic or Latino – A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race
White (not Hispanic or Latino) – A person having origins in any of the original people of Europe, North Africa, or the Middle East
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 original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Asian (not Hispanic or Latino) – A person having origins in any of the 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
American Indian/Alaskan Native (Tribal Affiliation) (not Hispanic or Latino) – A person having origins in any of the original peoples of North America, and South America (including Central America), and who maintain cultural identification through tribal affiliation or community attachment
Two or More Races (not Hispanic or Latino) – A person identified with two or more races and NOT of Hispanic origin
I do not want to self-identify my ethnicity
Gender
Male
Female
I do not want to self-identify my gender
Veteran Status
I am a protected veteran
I am NOT a protected veteran
I do not want to self-identify my veteran status
Find a location
What service would you like?
Alcohol & Substance Abuse
Medication Supported Recovery
Mental Health
Gambling
Prevention
Servicios Latinos
Email
This field is for validation purposes and should be left unchanged.
CLOSE