Equal Employment Opportunity Voluntary
Self-Identification Form

OMB No. 7100-0181
Average hours per response 1 minute
Approval expires October 31, 2017

  1.  
  2.  
  3. Gender Self Identification (Please mark only one):
  4. Race Self Identification (Please mark only one):

The Board is requesting that you furnish this information under the authority of 42 U.S.C. 2000e-16, which requires federal employment practices to be free of discrimination and provide equal employment opportunity for all. Providing this information is voluntary. Any information you voluntarily provide is confidential and will not be considered in making any employment decision. If you choose not to complete this form, it will not affect your being considered for employment. We ask for this information to maintain records. The information you provide on this form will be kept in a confidential file separate from your application for employment and will not be shared with selecting officials or other persons who make hiring decision.