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APPLICANT SELECTION CRITERIA RECORD

JOB TITLE
CANDIDATES CONSIDERED (INCLUDING MINORITIES AND FEMALES)

MALE/ ETHNIC ON LAB

NAME SECTION/
FEMALE CODE* OFF LAB

*ETHNIC CODES: 1-BLACK, 2-ORIENTAL, 3-HISPANIC, 4-AMERICAN INDIAN, 0-OTHER

CANDIDATE SELECTED
MALE/ ETHNIC
NAME SOURCE
FEMALE CODE

SELECTION CRITERIA

REASONS CANDIDATE SELECTED WAS PREFERABLE TO OTHERS

ORIGINATOR'S SIGNATURE DATE