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Because we do business with the US Government, we must reach out to, hire and provide equal opportunity to qualified individuals. To help us measure how we are doing, in the following screens we are going to ask you to provide us with information about your race, gender and if you have, or have had, a disability. As part of this procedure we are going to invite you to complete the following: Voluntary Self Identification of Gender, Ethnicity/Race Voluntary Self Identification of Disability Any answers you give will be kept private and will not be used against you in any way. You are not required to disclose any of this information and completion of the questionnaires is entirely voluntary. Once you have completed this process, you will be directed to our application.

Invitation to Self-Identify Gender, Ethnicity/Race Premier Heart and Vascular Center is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, we invite applicants and employees to voluntarily self-identify their gender, race and ethnicity. Submission of this information is strictly voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provision of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual. This information will be maintained separately from your application for employment. If you do not wish to self-identify at this time, you may do so in the future by submitting this form. Failure to provide the following information will not subject you to any adverse action or treatment. Premier Heart and Vascular Center is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

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