Voluntary Applicant Self Identification

INSTRUCTIONS

PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM

The Township is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, military status, genetic testing, or other unlawful bias except when such a factor constitutes a bona fide occupational qualification (BFOQ).  All personnel decisions and practices including, but not limited to, hiring, suspensions, terminations, layoffs, demotions, promotions, transfers, and evaluations, shall be made without regard to the above-listed categories.

Submission of this information is voluntary and your decision not to disclose any or all of this information will not subject you to any adverse treatment. 

Any self-identification information provided is kept separate from your application. The information obtained will be kept confidential within the Human Resources Department and may only be used in accordance with the provisions of applicable federal laws, executive orders, and regulations, including those which require the information to be summarized and reported to the Federal Government for civil rights enforcement purposes, in accordance with our Equal Employment Opportunity (EEO) Program. When reported, data will not identify any specific individuals.

For civil rights monitoring and enforcement purposes only, all race/ethnicity information will be collected and reported in the seven categories identified below. The definitions for each category have been established by the federal government. If you choose to voluntarily self-identify, you may mark only one of the boxes presented below.

INVITATION TO SELF-IDENTIFY

Invitation to Self-Identify
2. Gender Identification (check one):
3. Race / Ethnic Identification
4. Veteran Identification: Are you a veteran?
The term ‘‘eligible veteran’’ means a person who:

  • served on active duty for a period of more than 180 days and was discharged or released with other than a dishonorable discharge;
  • was discharged or released from active duty because of a service-connected disability;
  • as a member of a reserve component under an order to active duty pursuant to section 12301(a), (d), or (g), 12302, or 12304 of title 10, served on active duty during a period of war or in a campaign or expedition for which a campaign badge is authorized and was discharged or released from such duty with other than a dishonorable discharge; or
  • was discharged or released from active duty by reason of a sole survivorship discharge (as that term is defined in section 1174(i) of title 10).

5. Disability Identification: Are you a person with a disability?

The term disability is defined as:

  • physical or mental impairment that substantially limits one or more major life activities;
  • a record of such an impairment; or
  • being regarded as having an impairment that is not transitory and minor.

Major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, working, and the operation of major bodily functions (42 U.S.C. §§ 12101 et seq.).