Eeo Employer Form - PDF by oyr18472

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									                                            EEO SELF IDENTIFICATION




The Culture & Heritage Museums is an Equal Opportunity Employer. The information below is needed to measure
the effectiveness of our recruitment efforts and is in conformity with federal government guidelines, which require us to
compile statistical information about applicants for employment. You are not required to furnish this information, but are
encouraged to do so. The law provides that an employer may neither discriminate on the basis of this information nor on
whether you choose to furnish it. The Voluntary Information Sheet will be kept in a confidential file separate from the
Employment Application. Please indicate your preferences by placing an “x” in the appropriate boxes.

 NAME                                                           POSITION APPLIED FOR


 Please indicate your                 I wish to provide the                        I do not wish to provide the
 preference                           information                                  information
 GENDER: Please check the appropriate box                             Male                                Female

RACE/ETHNICITY: Please check one of the descriptions below corresponding to the ethnic group with which you
most identify.

      Hispanic or Latino          A person of Cuban, Mexican, Puerto Rican, South or Cenbtral American, or other Spanish
                                  culture of origin, regardless of race.
      White                       A person having origins in any of the original peoples of Europe, the Middle East or North
                                  Africa.
      Black or African            A person having origins in any of the Black racial groups of Africa.
      American
      Native Hawaiian or          A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other
      other Pacific Islander      Pacific Islands.
      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.
      American Indian or          A person having origins in any of the original peoples of North and South America (including
      Alaska Native               Central America), and who maintain tribal affiliation or community attachment.
      Two or more races           All persons who identify with more than one of the above races.


DISABLED/VETERAN CLASSIFICATION(S): Please indicate the category or categories that apply to you:

      Individual With a           •    Has a physical or mental impairment, which substantially limits one or more of your major
      Disability                       life activities; Has a record of such an impairment; or is regarded as having such an
                                       impairment
      Disabled Veteran            •    A veteran of the US military, ground, naval, or air service who is entitled to compensation
                                       (or who but for 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.
      Recently Separated          •    Any veteran during the three-year period beginning on the date of such veteran’s
      Veteran                          discharge or releave from active duty in the US military, ground, naval or air service.
      Armed Forces Service        •    Any veteran serving on active duty in the US military, ground, naval or air service,
      Medal Veteran                    participated in a United States military operation for which an Armed Forces service
                                       medal was awarded pursuant to Executive OPrder 12985.
      Other Protected             •    A veteran who served on active duty in the US military, ground, naval or air service
      Veteran                          during a war or in a campaign or expedition for which a campaign badge has been
                                       authorized, under the laws administered by the Department of Defense.


                                       AN EQUAL OPPORTUNITY EMPLOYER
                                                      REVISED May 2009

								
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