Skip Navigation
Geisinger: Professional >>
 

Employment Forms Home
Employment Information
Forms to Complete
Health Services
Hiring Documents Checklist
Hiring Documents FAQ
Orientation
Resident/Fellow Auxiliary
Educational Resources

 
Geisinger Medical Education
Screen saver
Download here
 
 
 

Employee Self-Identification

Please complete and submit the form below.

SELF-IDENTIFICATION FORM FOR
GEISINGER HEALTH SYSTEM EMPLOYEES
(To Be Completed By New Hires Only)
Geisinger Health System is an equal opportunity/affirmative action employer. As a federal contractor, we are required to keep records on the race, sex, and ethnicity of our employees and to file periodic reports with the government. Your participation is voluntary and will be kept confidential.
 
Part I - Sex, Race, Ethnicity
The following designations are those used by the Federal government. No other designations are available at this time. Please only mark one sex and one race/ethnic group.
Sex
Race
 
PART II - Identification as Covered Veteran
Choose Appropriately
 
If you are a qualified individual with a disability, we would like to include you under the affirmative action program. It would assist us if you tell us about (1) any special methods, skills and procedures which qualify you for positions that you might not otherwise be able to do because of your disability so that you will be considered for any positions of that kind for which you apply and (2) the accommodations which we could make would enable you to perform the job properly and safely, including special equipment, changes in the physical layout of the job, elimination of non-essential job functions, provisions of personal assistance services or other accommodations.
 
 
Copyright 2014 Geisinger Medical Center. 100 N. Academy Avenue. Danville, PA 17822
Terms & Conditions | Website Privacy Statement | Notice of Privacy Practices
This page was last modified on  12/09/2009