Required Fields Are In Red

First Name			Last Name
Address
City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces the Americas Armed Forces Europe Armed Forces Pacific American Samoa District of Columbia Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Puerto Rico Virgin Islands, U.S. Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Province du Quebec Saskatchewan Yukon Territory
Zip
Email			Telephone
Position
Tell us a little bit about yourself
Attachment
	(If submitting multiple files, please compress them into a single package)

---

Invitation to Self Identify: Gender, Ethnicity and Race

Below are three questions. The first is about your gender, the second is about your ethnicity, and the third is about your race. The questions are asked because Matthews International Corporation is subject to certain governmental recordkeeping and reporting requirements such as those in Executive Order 11246 and its regulations which require companies that do business with the federal government to collect gender, ethnicity, and race data on applicants for employment.

In compliance with applicable law, Matthews collects this data by offering applicants, on a voluntary basis, the opportunity to self identify their gender, ethnicity, and race. Therefore, you are requested to complete this form.

Note: The information disclosed by those self identifying is kept separate from the application for employment and is used only in accordance with the provisions of applicable laws, executive orders, and regulations.

Instructions

• Question 1 is self-explanatory.
• For Question 2, in accordance with governmental requirements, your race will not be reported if you select "Yes, Hispanic or Latino."
• For Question 3, and in accordance with governmental requirements, the summarized information on race will be reported for the following categories:
  1. White
  2. Black or African American
  3. Asian
  4. Native Hawaiian or Other Pacific Islander
  5. American Indian or Alaska Native
  6. Two or More Races (You will be reported to the Two or More Races category if you select more than one race.)

---

Question 1 - Gender	What is your gender? MALE FEMALE
Question 2 - Ethnicity	Are you Hispanic or Latino? YES, HISPANIC OR LATINO -- A person of Cuban, Mexican, Puerto Rican, South or Central America, or other Spanish culture or origin, regardless of race. NO, NOT HISPANIC OR LATINO.
Question 3 - Race	What is your race? (Select one or more of the following five categories.) 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. 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. NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER -- A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. 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 maintains tribal affiliation or community attachment.

If you do not wish to answer the above questions in whole or in part, please select the following:
DECLINE TO ANSWER

---