EEOC Self Identification The information requested below is used by the Company only to complete the annual U.S. Equal Opportunity Commission "Employer Information Report EEO-1" as required under Federal Law, 29 CFR Section 1602.7, and for the administration of civil right laws and regulations. In order to comply with these laws, we are requesting your cooperation in completing the EEO Self-Identification form. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse action. Name (please print) Position applied for SignatureDate MM slash DD slash YYYY 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. 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 Central American, or other Spanish culture of origin, regardless of race. White (not of Hispanic or Latino origin) - All persons having origins in any of the original peoples of Europe, the Middle East, or North Africa. Black or African American (not of Hispanic or Latino origin) - A person having origins in any of the black racial groups of Africa. Native Hawaiian or other Pacific Islander (not of Hispanic or Latino origin) - A person having origins in any of the peoples of Hawail, Guam, Samoa, or other Pacific Islands. Asian (not of Hispanic or Latino origin) - 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 Alaska Native (not of Hispanic or Latino origin) - A person having origins in any of the original peoples of the North and South American (including Central America), and who maintain tribal affiliation or community attachment. Two or More Races (not of Hispanic or Latino origin) - All persons who identify with more than one of the above five races. OR I decline to provide the Company with the requested information. EmailThis field is for validation purposes and should be left unchanged.