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Application for Employment

EE0-1 Employee Self-identification Form

Equal Employment Opportunity Notice: Every qualified person has an equal opportunity for hire, assignment and advancement without regard for race, color, religion, sex, national origin, age, disability as defined by law, or any other class protected by law.

This company is subject to mandatory federal government reporting and record keeping requirements for the administration of civil rights laws such as Title VII of the Civil Rights Act of 1964, as amended, administered by the US Equal Employment Opportunity Commission. Subsequently, our employees are asked to voluntarily self-identify their race/ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse or disciplinary action. The information will be kept confidential in a secured environment with limited access. The questions below are designed to identify gender, ethnicity and race. Regardless of your answer to question 2, please also answer question 3.

Sex

Ethnicity

Hispanic or Latino: a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.


Race

Please select the racial category with which you most closely identify below.

a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

a person having origins in any of the black racial groups of Africa.

a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

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.

a person having origins in any ot the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

All persons who identify with more than one of the above five race categories.