Work Authorization
Do you have permanent authorization to work in the United States?
*
Yes
No
Do You Require Visa Sponsorship?
Will you require visa sponsorship now or in the future?
*
Yes
No
Pronouns
What are your pronouns?
*
She/Her
He/Him
They/Them
Something else (please share below)
If something else:
Voluntary Self Identification
We invite you to complete this optional survey to help us evaluate our diversity and inclusion efforts. Submission of the information on this form is strictly voluntary and refusal to provide it will not subject you to any adverse treatment or affect your job application. Information obtained will be kept separate from your name or job application. This information will be kept secure and confidential and will be used solely to evaluate our diversity and inclusion efforts.
Please choose your race/ethnicity. Select all that apply
*
White / Caucasian
Hispanic, Latina/o, or Spanish origin
Black or African American
Asian
Native Hawaiian or other Pacific Islander
Indigenous Peoples, First Nations, Native American, or Alaska Native
Middle Eastern or North African
I choose not to disclose
Which gender identities do you most closely identify with?
*
Agender
Genderfluid
Genderqueer
Man
Woman
Non-binary
Something else
I choose not to disclose
Are you a veteran/have you served in the military?
*
Yes
No
I choose not to disclose
Do you have a disability?
*
Yes
No
I choose not to disclose
Yes, ECS Virtual Support - External can contact me about job opportunities.
I can opt-out at any time by unsubscribing or texting STOP. My data will be handled in accordance with
the privacy policy
. Terms of service:
https://loxo.co/legal/master-subscription-terms-of-service-agreement
. For help, email
support@loxo.co
.
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