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
What email address is best for contacting you?
*
What is the best phone number where you can be reached?
*
As part of our typical recruiting process, from time to time, we may contact you regarding positions that we feel are a good fit for you or engage with you during the recruiting process via SMS text message. Message and data rates may apply, depending on your mobile phone service plan. At any time you can get more help by replying HELP to these texts, or you can opt-out completely by replying STOP. Our Privacy Policy can be found at
https://www.blackmereconsulting.com/privacy-policy.
Do we have your consent to communicate with you via SMS text message moving forward?
*
-Yes
No
Where are you currently located (city, state)?
Are you open to relocation?
-Yes
Maybe
No
Not now, but would relocate later.
What is your compensation target? (number only)
Please provide any additional compensation details: bonus, LTI, RSU, STI, benefits, etc...
Do you require sponsorship to work in the U.S.?
*
EAD
Green Card
H1B Transfer
H1B new
OPT
TN Visa
U.S. Citizen - No Sponsorship Required
What is the highest level of education you've completed?
-High school or equivalent
Associates
Bachelors
Masters
PhD
What certifications are you currently holding, if any?
Do you currently have an Active Security Clearance?
*
-No
L (DOE)
Public Trust
Q (DOE)
Q SCI (DOE)
Secret (S)
Top Secret (TS)
Top Secret SCI (TS/SCI)
If you are placed with a government entity or company that requires the COVID-19 vaccination, are you willing to, or have you received, a vaccination?
*
No
Yes
Yes, Blackmere Talent Acquisition can contact me about job opportunities.
I may receive phone/text communications about career opportunities, interviews, job offers, and other related information from Blackmere Talent Acquisition (+1 (415) 510-2973, +1 (415) 813-1988, +1 (415) 384-5530, +1 (415) 449-8353 or +1 (415) 649-1366) (Message and data rates may apply, message frequency varies). I may receive emails from blackmereconsulting.com. 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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