HUDSON HUMAN RESOURCES

AFFIRMATIVE ACTION INFORMATION

In an effort to implement our voluntary government affirmative action program record keeping and reporting requirements, we ask that you complete this data survey. The information concerning status as an individual with a disability and veteran status may also be used to help you take advantage of the Company’s affirmative action program for individuals with a disability and covered veterans. Your cooperation is appreciated. Providing this information is STRICTLY VOLUNTARY. Failure to provide it will not subject you to discharge or discipline or any other negative personnel action. Information provided will be kept confidential in accordance with applicable regulations. If you choose not to disclose the information requested below, please be sure to complete the first section and check the box indicating ‘I Decline to Self Identify’ below.

Name: Gender: Male Female Date:
Position Applied For:
Practice Group:
Divisional Services / Legal / Professional Resources
City and State:
CHECK ONE OF THE FOLLOWING RACE / ETHNIC GROUPS
1. / Are you Hispanic or Latino? Yes No
2. / If you answered, “No”, please select from one of the following options
American Indian or Alaskan Native (Not Hispanic or Latino / Native Hawaiian or Pacific Islander (Not Hispanic or Latino)
Asian (Not Hispanic or Latino / White or Caucasian (Not Hispanic or Latino
Black or African American (Not Hispanic or Latino) / Two or More Races (Not Hispanic or Latino
I Decline to Self Identify
CHECK AS MANY OF THE FOLLOWING AS ARE APPLICABLE
Armed Forces Service Metal Veterans – If yes, please give dates of service:______
Disabled Veteran – If yes, please explain and suggest any ways we can accommodate your disability to assist you in performing your job. Use back side of this sheet for additional space, if necessary:______
Recently Separated Veteran – If yes, please give dates of separation:______
Other Protected Veteran – If yes, please give dates of service and name of war, campaign or expedition:______
Individual with a Disability – If yes, please explain and suggest any ways we can accommodate your disability to assist you in performing your job. Use back side of this sheet for additional space, if necessary:______

HUDSON HUMAN RESOURCES

EEOC RACE/ETHNIC IDENTIFICATION CATEGORIES

‘White or Caucasian (Not Hispanic or Latino)” - All persons having origins in any of the original peoples of Europe, Middle East, or North Africa.

“Black or African American (Not Hispanic or Latino)” - All persons having origins in any of the Black racial groups of Africa.

“Hispanic or Latino” - A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin regardless of race.

“Asian (Not Hispanic or Latino)” - All persons 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.

“Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)” - All persons having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

“American Indian or Alaskan Native (Not Hispanic or Latino)” - All persons having origins in any of the original peoples of North America and South America (including Central America), and who maintain tribal affiliation or community attachment.

“Two or More Races (Not Hispanic or Latino)” - All persons who identify with more than one of the above six races.

MILITARY / DISABILTIY CATEGORIES

“Armed Forces Service Medal Veterans” means any 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 pursuant to the Executive Order 12985.

“Disabled Veteran” means any veteran of the U.S. military, ground, naval or air service who (1) 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 Veteran Affairs, or (2) was discharged or released from active duty because of a service-connected disability.

“Recently Separated Veteran” means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval or air service.

“Other protected veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

“Individual with a disability” means any person who (1) has a physical or mental impairment which substantially limits one or more of such person’s major life activities, (2) has a record of such an impairment, or (3) is regarded as having such an impairment.

IF COMPLETED, PLEASE RETURN TO HUMAN RESOURCES.