EEO Data Form


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									This EEO (Equal Employment Opportunity) Data Form is given to employment
candidates for data collection purposes as required by law. An employer subject to the
reporting requirements of the Equal Employment Opportunity Commission (EEOC)
should collect this completed form from prospective candidates during the hiring
process. The EEOC uses this information to sustain civil rights enforcement and to
evaluate employment patterns, such as the representation of minority and female
workers within companies and industries. The collection of this data will ensure that the
company complies with all federal laws. This form should be used by the human
resources department of companies that are required to report to the EEOC.
                                       EEO Data Form:
The information requested is being collected for the purpose of reporting to Federal and Equal
Employment Opportunity Agencies and will not be considered as part of the application for
employment. It will be separated from the application.

1. Job Posting Number _______________ [Instructions: insert number]

2. Social Security No. _______________ [Instructions: insert social security number]

3. Name _______________ [Instructions: insert first, middle, and last name]

4. Address _______________ [Instructions: insert city, state, and zip code]

5. Phone Number _______________ [Instructions: insert phone number]

6. Sex: _______________ [Instructions: insert M or F]
         F- Female

7. Birth Date _______________ [Instructions: insert date]

8. Ethnic Origin _______________ [Instructions: insert corresponding letter code]
W-White B-Black H-Hispanic P- Asian/Pac Islander I-. Am.Ind/Alaskan O-Other

9. How did you find out about this job? _______________ [Instructions: insert number
01 – Newspaper 02 - Job Fair 03 - Professional Publication 04 - Recruitment Poster
05 - Newspaper 06 - College/University Career Day 07 - Governor’s Job Bank
08 - Human Resource Services/Personnel Office 09 - Other (specify):_______________
[Instructions: insert additional way how user found out about job, if applicable]

X _______________ [Instructions: insert signature and date]
Signature and Date

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