New Hire EEO Self-Identification Form

Full Name

Job Title

Department

Email Address

Gender

Female Male I do not wish to disclose

Race/Ethnicity

American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Two or More Races I do not wish to disclose

Disability Status

Yes, I have a disability (or previously had a disability) No, I do not have a disability I do not wish to disclose

Veteran Status

I identify as one or more of the classifications of Protected Veteran I am not a Protected Veteran I do not wish to disclose