Our Bank is an equal opportunity employer and does not discriminate in hiring or employment decisions on the basis of race, color, religion, sex, national origin, age, disability, or any other category protected by federal, state, or local law. No question on this form is intended to secure information to be used in such a manner. We are subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, we invite our employees to voluntarily self-identify their race, ethnicity, gender, and veteran status. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.
The following ethnic categories are defined by federal regulations. For purposes of this voluntary form, please check one of the following with which you best identify or belong:
WHITE (not of Hispanic origin)- A person having origins in any of the original peoples of Europe or the Middle East, or North Africa.
BLACK OR AFRICAN AMERICAN (Not Hispanic or Latino)- A person having origins in any of the black racial groups of Africa.
ASIAN (Not Hispanic or Latino) - 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.
AMERICAN INDIAN OR ALASKAN NATIVE (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
HISPANIC OR LATINO - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish Culture or origin regardless of race.
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER (Not Hispanic or Latino)- A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
TWO OR MORE RACES - A person who identify with more than one of the above five races.
III. OTHER INFORMATION
SPECIAL DISABLED VETERAN - Persons who served in 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 Department of Veterans’ Affairs for a disability a) rated at 30 percent or more, or b) rated at 10 or 20 percent in the case of a veteran who has been determined under section 38 U.S.C. 3106 to have a serious employment handicap or ii) a person who was discharged or released from active duty because of a service-connected disability.
VIETNAM ERA VETERAN - Persons who either Served on active duty for a period of more than 180 days, any part of which occurred between 08-05-64 & 05-07-75, where discharged or released there from with other than a dishonorable discharge. Were discharged or released from active duty for a service connected disability if any part of such duty was performed between 08-05-64 & 05-07-75.
NEWLY SEPARATED VETERAN – Any veteran who served on active duty in the U.S. military, ground, naval or air service during the one-year period beginning on the date of such veteran’s discharge or release from active duty.
OTHER PROTECTED VETERAN – Persons 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.
DISABLED INDIVIDUAL – Persons who a) has a physical or mental impairment that substantially limits one or more of such person’s major life activities; b) has a record of such impairment; or c) is regarded as having such impairment. For purposes of this part, a disabled individual is “substantially limited” if he or she is likely to experience difficulty in securing, retaining or advance in employment because of handicap.
COMPLETION OF THIS FORM IS NOT MANDATORY, IT IS VOLUNTARY
If you have any questions regarding this form, please contact the Human Resource Department
I authorize this information to be accurate to the best of your knowledge.