In consideration for using the services and programs of the University of Texas at Arlington, I, the undersigned, agree to comply with Title VII of the Civil Rights Act of 1964, as amended, 42 U.S.C. 2000e et. Seq., which states in part that it shall be an unlawful employment practice for an employer:

"To fail or refuse to hire or discharge any individual, or otherwise to discriminate against any individual with respect to his/her compensation, terms, conditions, or privileges of employment, because of individual’s race, color, religion, sex, national origin, age, disability, or to limit, segregate, or classify employees or applicants for employment in any way which otherwise adversely affect his/her status as an employee, because of such individual’s race, color, religion, sex, national origin, age or disability or veteran status."

COMPANY NAME:_______________________________________________________________________________________

DIVISION:______________________________________________________________________________________________

SIGNATURE:____________________________________________________________________________________________

PLEASE PRINT NAME:____________________________________________________________________________________

POSITION/TITLE:_________________________________________________________________________________________

DATE:__________________________________________________________________________________________________

PHONE:_________________________________________________________________________________________________