Form Center

2. 
3. BRAZOS COUNTY
   Voluntary EEO Self-Identification Form
5. In an effort to comply with requirements regarding government record keeping, reporting, and other legal oligations which may apply, we invite you to complete this Voluntary EEO Self-Identification form. Providing this information is strictly voluntary. Failure to provide it will not subject you to any adverse personnel decision or action. Your cooperation is appreciated.
7. Name
8. Date
10. Position
11. Department
13. Gender

    1. Male

    1. Female
15. Ethnicity: (check all that apply)
17. 1. Asian/Pacific Islander

    All persons having origins in any of the original peoples of the Far East, Indian Subcontinent, Southeast Asia or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands and Samoa.
19. 1. Black

    All persons having origins in any of the black racial groups of Africa.
21. 1. Hispanic

    All persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture/origin, regardless of race.
23. 1. American Indian/Alaskan

    All persons having origins in any of the original peoples of North America.
25. 1. White

    All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field