Our Mission Our Values Strategic Plan Goals Annual Report Notice of Privacy Cultural Diversity Financial Information Board of Directors Contact Us Detoxification Services Adult Services Adolescent Services Women's Programs Public Safety Services Engagement Center Mental Health Services Job Opportunities Benefits Apply Online Diversity		Employment Opportunities Affirmative Action Form Maryhaven is an Equal Opportunity/ Affirmative Action Employer. To help us comply with federal/state equal opportunity recordkeeping, reporting, and other legal requirements, please answer all questions below as they apply. Submission is voluntary. Failure to supply this information will not jeopardize or adversely affect any consideration you may receive for employment, or later advancement in employment. This form will be retained in a confidential file separate from the employment application. Name:   Sex:   Male Female Race / Ethnicity: Please select one category   Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or Spanish culture or origin regardless of race.     White (Not Hispanic or Latino) - A person having origin in any of the original peoples of Europe, the Middle East, or North Africa.     Black or African American (Not Hispanic or Latino) - A person having origin in any of the black racial groups of Africa.     Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origin in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.     Asian (Not Hispanic or Latino) - A person having origins in any of the original 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 or Alaska Native (Not Hispanic or Latino) - A person having origin in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.     Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races, with the exception of the Hispanic or Latino race. Veteran Status: Veteran Non-Veteran Please identify where you learned about an employment opportunity with Maryhaven. Newspaper Walk-in Employee Referral Maryhaven Website Other, Please describe I refuse to voluntarily self identify at this time. Copyright © 2005 Maryhaven.