New Hire Additional Information Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastDate of Birth (Not today's date) *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeContact Phone *LayoutAre you a United States citizen? *YesNoGender *MaleFemaleOtherLayoutRace *White (Not of Hispanic origin)Black (Not of Hispanic origin)HispanicAsian or Pacific IslanderAmerican Indian or Alaskan NativeMarital Status *SingleMarriedWidowedDivorcedVeteran Status (Check all that apply) *Special Disabled Veteran – refers to a veteran who is entitled to compensation (or who, but for the receipt of military retired pay, would be entitled to compensation) under laws administered by the Dept of Veterans Affairs for a disability rated at 30% or more, or rated at 10% or 20% in the case of a veteran who has been determined by the Dept of Veterans Affairs to have a serious employment handicap. The term also refers to a person who was discharged or released from active duty because of service-connected disability.Vietnam Veteran - Persons who served on active duty for more than 180 days, and was discharged or released there from with other than a dishonorable discharge, if any part of such active duty occurred in the Republic of Vietnam between February 28, 1961, and May 7, 1975, or between August 5, 1964, and May 7, 1975, in all other cases. The term also refers to person who was discharged or released from active duty for a service-connected disability if any part of such active duty was performed in the Republic of Vietnam between February 28, 1961, and May 7, 1975 or between August 5, 1964, and May 7, 1975, in all other cases.Newly Separated Veteran – Hire date is within one year of being discharged or released from active duty.Other Veteran - Served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized. Campaign list available upon request.Not a VeteranForeign Language and Sign Language Capability LayoutEnter Language 1For Language 1:I can speak.I can read.I am fluent.Layout (copy)Enter Language 2For Language 2:I can speak.I can read.I am fluent.I am fluent in American Sign Language.YesNoSubmit