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PLEASE READ CAREFULLY Federal law and regulations require U.S government contractors, such as Fakouri Electrical Engineering, Inc.(FEE), to monitor their equal employment opportunity compliance on a continuing basis. We are therefore requesting that individuals applying for employment with FEE provide information on their gender and group status by checking the applicable boxes below. The information you furnish will be maintained only for the purpose of monitoring compliance with applicable laws and regulations concerning equal employment opportunity and will not be used for any other purpose. Please note that submission of this information is voluntary. However, we still need to receive an Equal Employment Opportunity Form from you, even if you choose not to provide gender and group statsu information. Until this form is received, we are , unfortunately, unable to consider your name for this job position/assignment. Thank you.

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Group Status*  White (not of HYispanic or Latino origin)  Hispanic or Latino  American Indian or Alaskan Native  Asian (not of Hispanic or Lation origin)  Native Hawaiian or Other Pacific Islander (not of Hispanic or Latino origin)  Two or more races (not of Hispanic or Latino origin)

Gender*  Male   Female

Yes   No   Are you a veteran?   if "yes" Are you Disabled Veteran?  Yes   No

Yes   No   Are you a Vietnam-era veteran?

Yes   No   Have you been determined to be a special disabled veteran?

Yes   No   Other Protected Veteran?

Yes   No   Are you a recently separated veteran? Active Duty Release Date     MM/DD/YYYY

Initial:      Date:      MM/DD/YYYY