Equal Employment Opportunity to Self-Identify EEOC Form "*" indicates required fields EQUAL EMPLOYMENT OPPORTUNITY INVITATION TO SELF-IDENTIFYUnder Federal law, Beacon Hill Staffing Group is required to collect and report statistics about its applications and employees. To ensure that Beacon Hill Staffing Group is an equal opportunity employer, we are asking you to submit the following information. It's completely up to you if you would like to tell us about your gender, ethnicity, race, and veteran status. We will not base our decisions on whether you have filled out the form or not. Please fill in your name at the bottom. Beacon Hill Staffing Group appreciates your cooperation. Gender* Female Male Non-Binary/Third Gender I do not wish to disclose Ethnicity and Race DefinitionsETHNICITY Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. RACE (not Hispanic or Latino) American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. 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. Black or African American - A person having origins in any of the Black racial groups of Africa. Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White - A person having origins in any of the original peoples of Europe, North Africa, or the Middle East. Two or More Races - All persons who identify with more than one of the above five races.Ethnicity*Please refer to Ethnicity and Race Definitions for details. Hispanic or Latino Not Hispanic or Latino I do not wish to disclose Race*Please refer to Ethnicity and Race Definitions for details. American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Two or More of the above five Races I do not wish to disclose Protected Veteran DefinitionsActive Duty Wartime or Campaign Badge Veteran - A veteran of the US military who served on active duty in the U.S. military, ground, naval or air service either (1) during a war or (2) in a campaign or expedition for which a campaign badge has been authorized, under the laws administered by the Department of Defense. Armed Forces Service Medal Veteran - A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded. Disabled Veteran - (1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs, or (2) A person who was discharged or released from active duty because of a service-connected disability. Recently Separated Veteran - A veteran of the US military during the three-year period after the date of the veteran’s discharge or release from active duty.Protected Veteran* Yes No I do not wish to disclose HiddenName* First Last HiddenDate* MM slash DD slash YYYY HiddenEmail HiddenE-Signature*I understand by entering my name I am confirming my selections by way of a "digital signature". Digital Signature Consent HiddenVoluntary Self-Identification of DisabilityWhy are you being asked to complete this form?Because we conduct business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help up measure how well we are doing, we are asking you to tell use if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier. How do you know if you have a disability?You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include but are not limited to; Blindness Autism Bipolar disorder Post Traumatic Stress Disorder (PTSD) Deafness Cerebral palsy Major depression Obsessive Compulsive Disorder Cancer HIV/AIDS Multiple Sclerosis Impairments requiring the use of a wheelchair Diabetes Schizophrenia Missing limbs or partially missing limbs Intellectual disability (previously called mental retardation) Epilepsy Muscular dystrophy Please select on of the options below:* Yes, I have a disability (or previously had a disability) No, I don't have a disability I do not wish to answer Name* First Last Date* MM slash DD slash YYYY E-Signature* Digital Signature Consent I understand by entering my name I am confirming my selections by way of a "digital signature". Reasonable Accommodation NoticeFederal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to preform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in a alternate format, using a sign language interpreter, or using specialized equipment. Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Program (OFCCP) website at, www.dol.gov/ofccp. Public Burden Statement - According to the Paper Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete. CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
