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EEO-1 Self-Identification Form (optional)
If you wish to be identified, please sign below and complete the survey:
What do you identify as?
Are you Hispanic or Latino?
No, I am not Hispanic or Latino.
Yes, I am Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race.
Race – IMPORTANT - Only complete this section if you checked “No, I am not Hispanic or Latino” in the Ethnicity section above:
What is your race? Select ONE of the following categorie(s):
White – A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.
Black or African American - A person having origins in any of the Black racial groups of Africa.
American Indian/Alaskan Native - A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment.
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 original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Two or More Races - All persons who identify with more than one of the above five races.
(If federal contractor/subcontractor with affirmative action obligations – add the following section) Check if the following is applicable:
A Protected Veteran is defined as follows:
served on active duty for a period of more than 180 days, and any part of which occurred between August 5, 1964 and May 7, 1975 and were discharged or released other than dishonorably; or,
was discharged or released from active duty for a service connected disability if any part of the active duty was performed between August 5, 1964 and May 7, 1975; or
who served on active duty in the U.S. military, ground, naval, or air service during a war or in a campaign or expedition for which a campaign badge has been authorized (such as The Persian Gulf, El Salvador, Grenada, Lebanon, Panama, Southwest Asia, Haiti, Somalia & Bosnia); or
one who served on active duty in the U.S. military, ground, naval or air service during the one-year period beginning on the date of discharge or release from active duty (recently separated veteran).
Are You a Protected Veteran?
This field is for validation purposes and should be left unchanged.
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