Voluntary Self-Identification Form (EEO/Affirmative Action)

Voluntary Self-Identification Form (EEO/Affirmative Action)

(For Applicants)
Hercules is an equal opportunity/affirmative action employer. As a Government contractor, we are subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U. S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment protected veterans. Hercules will take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Completion of this form is voluntary and will not affect your opportunity for employment, or terms or conditions of employment. The information you provide will be kept confidential and it will not be used in a manner inconsistent with the act. Refusal to provide information will not subject you to any adverse treatment.
Name

First Name Last Name
Position Applied For
Gender

Male Female Prefer not to answer
Race / Ethnicity (Check all that apply)

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, 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. 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. 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 Alaska 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 maintains tribal affiliation or community attachment. Two or more races (Not Hispanic or Latino): All persons who identify with more than one of the above five races. I don’t wish to answer.
PROTECTED VETERANS

If you believe you belong to any of the categories of protected veterans listed below, please indicate by checking the appropriate box below.
A “disabled veteran” is one of the following:

• 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

• A person who was discharged or released from active duty because of a service-connected disability.

A “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.

An “active duty wartime or campaign badge 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.

An “Armed forces service medal veteran” means 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 pursuant to Executive Order 12985.
Check the box that applies to you:

I identify as one or more of the classifications of protected veteran listed below I am not a protected veteran I don't wish to answer
Should be Empty:

Voluntary Self-Identification Form (EEO/Affirmative Action)

PROTECTED VETERANS