This form has been designed to comply with state and federal fair employment practice laws prohibiting discrimination on the basis of an applicant's sex or minority status.

Questions directly or indirectly reflecting such status have been included only where needed to determine a bona fide occupational qualification or for other permissible purposes.

Such questions are appropriately noted on the application.

Notwithstanding these efforts, the manufacturer of this form assumes no responsibility and hereby disclaims any liability for inclusion in this form, of any questions upon which a violation of state and federal fair employment practice laws may be based.