AFFIRMATIVE ACTION VOLUNTARY INFORMATION

THE CITIZENS BANK OF OVIEDO
PO BOX 620729
OVIEDO, FL 32762-0729

*Completion of Information Below is Voluntary*

We consider all applicants for positions without regard to race, color,
religion, sex, national origin, age, veteran/reserve/national guard
or any other similarly protected status.

To be completed by applicant on a voluntary basis. Not for interview
purposes. To be filed separately from application.

In an effort to comply with requirements regarding government record-
keeping, reporting and other legal obligations which may apply, we
invite you to complete this applicant data survey. Providing this 
information is STRICTLY VOLUNTARY. Failure to provide it will not
subject you to any adverse personnel decision or action. Your coopera-
tion is appreciated.

Please be advised that this survey is -not- a part of your official 
application for employment. It will not be used in any hiring 
decision. The information will be used and kept confidential in
accordance with applicable laws and regulations.

***********************************************************************
PLEASE PRINT

Position(s)applied for _________________________________Date___/___/___

REFERRAL SOURCE
[ ] Walk-in		[ ] Government Employment Agency	
[ ] Employee		[ ] Private Employment Agency
[ ] Relative		[ ] School
[ ] Advertisement-Source____________________________
[ ] Other___________________________________________

Name of person who referred you (if applicable):_______________________
_______________________________________________________________________
***APPLICANT INFORMATION***

Name___________________________________________________________________
	Last                      First              Middle

Address________________________________________________________________
	        Street                       	    Apt#/Suite

City_________________________________   State_______	Zip____________

[ ] Male   [ ] Female		Telephone (_____)______________________

PLEASE CHECK ONE OF THE FOLLOWING EQUAL EMPLOYMENT OPPORTUNITY
IDENTIFICATION GROUPS:
[ ] White (not of Hispanic origin)   [ ] Black (not of Hispanic origin)
[ ] Hispanic			     [ ] American Indian/Alaskan Native
[ ] Asian/Pacific Islander

_______________________________________________________________________
***FOR ADMINISTRATIVE USE ONLY***

Position(s) applied for  [ ] Available    [ ] Not available

Other positions considered for_________________________________________

Hired [ ] Yes    [ ] No

Position hired for______________________________Date of hire___/___/___

From the EEO job classification listed below, which one best describes
the position filled
[ ] Officials and Managers		[ ] Sales Workers
[ ] Operatives (semi-skilled)  	        [ ] Professionals
[ ] Office and Clerical Workers		[ ] Laborers (unskilled)
[ ] Technicians				[ ] Craft Workers (skilled)
[ ] Service Workers

Notes__________________________________________________________________

_______________________________________________________________________

Completed by______________________________________  Date ____/____/____