U.S. Equal Employment Opportunity Information

U.S. Equal Employment Opportunity Information

Individuals seeking employment are considered without regards to race, color, religion, national origin, age, sex,
marital status, ancestry, physical or mental disability, veteran status, or sexual orientation. You are being given
the opportunity to provide the following information in order to help us comply with federal and state Equal
Employment Opportunity/Affirmative Action record keeping, reporting, and other legal requirements.

Completion of the form is voluntary. Refusal to provide the requested information will not subject you to any
adverse treatment. Any information that you do provide will be kept confidential as required by law.

Gender

Male

Female

I choose not to self-identify

Race/Ethnicity

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

White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent

Native American or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

Two or More Races (Not Hispanic or Latino): All persons who identify with more than one of the above five races.

I do not wish to answer

Veteran Status

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories is as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Veteran Status

I identify as one or more of the classifications of protected veterans listed above

I am not a protected veteran

I do not wish to answer

Disability Status

We endeavor to reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability.

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

Blindness
Autism
Bipolar disorder
Post-traumatic stress disorder (PTSD)
Deafness
Cerebral palsy
Major depression
Obsessive compulsive disorder
Cancer
HIV/AIDS
Multiple sclerosis (MS)
Impairments requiring the use of a wheelchair
Diabetes
Schizophrenia
Missing limbs or partially missing limbs
Intellectual disability (previously called mental retardation)
Epilepsy
Muscular dystrophy

Disability Status

Yes, I Have A Disability, Or Have A History/Record Of Having A Disability

No, I Don’t Have A Disability, Or A History/Record Of Having A Disability

I Don’t Wish To Answer

Full Name

Signed Date

U.S. Equal Employment Opportunity Information

Please sign below using your mouse

Please enter note below