EEO Form

CamTran’s REVISED Equal Employment Opportunity (EEO) Self-Identification Form

Cambria County Transit Authority | 502 Maple Avenue | Johnstown, PA 15901
INSTRUCTIONS

PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM

Anti-Discrimination Notice. It is an unlawful employment practice for CamTran to fail or refuse to hire or discharge any individual, or otherwise to discriminate against any individual with respect to that individual’s terms and conditions of employment, because of such individual’s race, color, religion, national origin, sex (including gender identity, sexual orientation, and pregnancy), age, genetic information, disability, veteran status, or other protected class.

CamTran is subject to certain nondiscrimination and affirmative action recordkeeping and reporting requirements which require CamTran to invite employees to voluntarily self-identify their gender, race/ethnicity, veteran status and disability status. 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.

We are an organization that values diversity and encourages women and minorities to apply. For this reason, we invite you to indicate your gender, race/ethnicity, and veteran and disability status below.

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.
Name

First NameMiddle InitialLast NameSuffix
Position(s) for which you are applying*

Service Manager / Inventory Control SpecialistDirector of Marketing and CommunicationFacilities Laborer/ IP Maintenance ApprenticeRural CustodianMechanicRural Bus Operator (Part-time)Urban Bus Operator (Part-time)Inclined Plane Operator/ Conductor/ ClerkInclined Plane Conductor/ ClerkBus Stop Shop ClerkCustomer Service ReservationistOther
INVITATION TO SELF-IDENTIFY

PLEASE ANSWER THE FOLLOWING QUESTIONS
Gender Identification: What is your Gender? (Check one)*

MaleFemaleI do not wish to disclose.
Race/Ethnic Identification: What is your race/ethnicity? Please mark the one box that describes the race/ethnicity category with which you primarily identify.

Hispanic or Latino: a person of Cuban, Mexican, Chicano, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.White: a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.Black or African American: a person having origins in any of the black racial groups of Africa.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.Native Hawaiian or Other Pacific Islander: a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.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.Two or More Races: a person who primarily identifies with two or more of the above race/ethnicity categoriesI do not wish to disclose.
Veteran Identification: Are you a veteran?

The term ‘‘eligible veteran’’ means a person who:
1. served on active duty for a period of more than 180 days and was discharged or released therefrom with other than a dishonorable discharge;
2. was discharged or released from active duty because of a service-connected disability;
3. 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
4. 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).
Yes, I identify as one or more of the classifications of veteran listed.No, I am not a Veteran.I do not wish to disclose.
Disability Identification: Are you a person with a disability?

The term disability is defined as:
1. physical or mental impairment that substantially limits one or more major life activities;
2. a record of such an impairment; or
3. 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.).
YesNoI do not wish to disclose.
Should be Empty:

CamTran’s REVISED Equal Employment Opportunity (EEO) Self-Identification Form