Applicant Identification Information L-3 Vertex

For Record Keeping Purposes Only

This is NOT an Application for Employment!
An Equal Opportunity Employer

Candidate Self Identification Information Date: 4/10/2007

Thank you for considering L-3 Vertex as a potential employer.

Because L-3 Vertex is a government contractor, we are required by law to gather EEO information. The
information below is completely voluntary and will in no way determine a decision concerning employment.

If you have applied for one of our positions, please save this form to your computer, complete it and email
it to hr.staffing@L-3com.com. If you did not apply for a position, please do not complete this form.

Thank you for your assistance in helping our company comply with this federal law!

We would appreciate each candidate to voluntarily provide the information requested below. The information will be used for
recordkeeping purposes only. The form will not be used in the employment selection or decision. L-3 Vertex is a government
contractor and responsible for preparation and maintenance of a Affirmative Action Programs for minorities, females, Veterans
(including Disabled, Vietnam Era Veterans).

Candidate Name (Print) Position Number/Title

Johnathan K. Spencer Raym1318 Warehouseman

Gender: Male Female

Please Check One Box To Indicate Your Racial Ethnic Background

White (Not of Hispanic origin) Black or African Amer. (Not of Hispanic origin)

A person with origins in any of the original A person with origins in any of the Black
peoples of Europe, North Africa, or the Middle Racial Groups of Africa who is also not of
East who is not of Hispanic origin. Hispanic origin.

Asian Americian Indian or Alaskan Native

A person with origins in any of the original
peoples of the Far East, Southeast Asia, the
Indian Subcontinent. This area includes
for example, Cambodia, China, India, Japan,
Korea, the Phillippine Islands, Thailand and
Vietnam.
A person with origins in any of the original
peoples of North America and South America
(including Central America) who maintains Cultural
identification through tribal affiliation or
community attachment.

Hispanic or Latino (Ethnicity) Hawaiian or Pacific Islander

A person of Mexican, Puerto Rican, Cuban, Native Hawaiian or Other Pacific Islander --
South American, central America or A person having origins in any of the original.
other Spanish culture or origin regardless of Peoples of Hawaii, Guam, Samoa or other
Race. Pacific Islands.

Two or More Races Decline to give this informatin at this time.

All persons who identify with two or races I understand that this will not affect my being
Of the above five races. Considered in the application process.

HR-F-089 (7/98)
Revision: 11/23//06

This Is Not An Employment Application

An Equal Employment Employer (M/F/V/D)