Form - EEOC - HomeCentris Healthcare

Equal Employment Opportunity Data (optional)

Introduction

HOMECENTRIS HEALTHCARE, LLC AND ITS SUBSIDIARIES (“HOMECENTRIS”) PROVIDE EQUAL OPPORTUNITY TO ALL QUALIFIED INDIVIDUALS, WITHOUT REGARD TO RACE, COLOR, RELIGION, AGE, SEX, NATIONAL ORIGIN, MARITAL STATUS, VETERAN STATUS, DISABILITY OR OTHER LEGALLY PROTECTED STATUS, IN CONFORMITY WITH ALL FEDERAL AND STATE LAWS.

Employers collect data to provide periodic reports to the United States government regarding the sex, ethnicity, disability or other protected status of employees and applicants. In order for HomeCentris to comply with government record keeping, reporting, and other legal requirements, we ask you to voluntarily provide the information requested below. Please be aware that you are not obligated to complete this form, and that any information you do provide voluntarily will be treated strictly confidentially and kept separate from the Application for Employment. Inclusion or exclusion of requested information will have no effect on further employment consideration or hiring decisions.

Participation: *

I elect to voluntarily provide the information requested below

I decline to provide the information requested below.

Form – EEOC