Thank You for Your Application

It is the policy of Signal Peak Energy, LLC to provide equal employment opportunity to all employees and applicants for employment without regard to gender, race, color, religion, sexual orientation, national origin, disability, or disabled or Vietnam-Era veterans’ status, or any other status protected under state and federal laws.

VARIOUS AGENCIES OF THE UNITED STATES GOVERNMENT REQUIRE EMPLOYERS TO COLLECT INFORMATION ON APPLICANTS. INFORMATION REQUESTED ON THIS SHEET IS FOR PURPOSES OF COMPLIANCE WITH THESE RECORDKEEPING REQUIREMENTS AND TO DETERMINE RECRUITING AND EMPLOYMENT PATTERS. If you wish to be identified, please provide any of the information requested on this form that you would like to submit. You may submit this information now or at any time in the future. Such information will in no way affect the decision regarding your application for employment. This sheet will be kept confidential and maintained separately from your application form.

Completion of This Form Is Voluntary and Is Not a Requirement for Employment

Name Date

Position Applied For

Gender

Male Female

Race/Ethnicity

(Please check one of the descriptions below corresponding to the ethnic group with which you identify.)

Hispanic or Latino / A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White / A person having origins in any of the original peoples of Europe, the Middle East or North Africa. Black or African American / A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander / A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands. Asian / A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam. American Indian or Alaska Native / A person having origins in any of the original peoples of North and South America (including Central America) and who maintain tribal affiliation or community attachment. Two or More Races / All persons who identify with more than one of the above five races.