Employee EEO Self-Identification Form
Notice - Completion of this form is voluntary. We are an Affirmative Action, Equal Opportunity Employer. Our employment decisions are made
without regard to race, color, religion, gender, national origin, age, disability, marital status, veteran or military status, or any other legally protected status. The purpose of this Employee EEO Self-Identification Form is to comply with federal government record-keeping and reporting requirements. Periodic reports are made to the government on the following information. The data you provide on this form will be kept confidential and used solely for analytical and reporting requirement purposes. This form is processed and maintained separately from your personnel file and is not used to make decisions about the terms and conditions of employment. We appreciate your assistance.