DIVERSITY INFORMATION
The following data is required to complete HFHS equal opportunity and affirmative action record
keeping and reporting. Please complete and return with your signed contract. Thank you.
Date:
Print Name:
Signature:
GME Program:
GENDER:
Male
Female
RACE / ETHNIC GROUP:
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 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 five races.
Qualified applicants are considered for employment, and employees are treated during employment, without regard to race, color, religion,
sex, national origin, age, marital status, medical condition, or disability. Please complete this information to assist us in complying with equal
opportunity/affirmative action record keeping and reporting requirements. This Information Form will be kept in a separate, confidential file
and will be used only for safety and government reporting purposes.