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Patient Information Form Circle/Fill in all applicable. Name: Prefers to be called: Address: City State Zip Date of Birth: Sex: Primary Language: Race: (American Indian, African American, Caucasian,
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Native Americans and jobs refer to employment opportunities and participation in the workforce specifically for Native American individuals.
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Employers who have Native American employees or offer job opportunities to Native Americans are required to file native americans and jobs.
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Information such as the number of Native American employees, job titles, wages, and any special programs or initiatives for Native Americans must be reported on native americans and jobs.
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