Ford Accepting Our Employment Offer Page 4
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7VOLUNTARY SUPPLEMENTAL INFORMATION:
The following VOLUNTARY information is requested for the purpose of preparing periodic reports to the government or other record-
keeping in connection with government requirements. We encourage you to complete this section, but your employment will not be
adversely affected should you choose not to provide this information
Last Name (Print)
First Name
M.I.
Global ID Number
(Leave blank if new hire)
GENDER/RACE/ETHNIC CATEGORIES (Refer to definitions below - Check one)
A
Hispanic or Latino Male
D
Black or African American Male
F
Asian Male
B
Hispanic or Latino Female
J
Black or African American Female
L
Asian Female
C
White Male
E
Native Hawaiian or Pacific Islander
G
American Indian / Alaska Native Male
Male
I
White Female
K
Native Hawaiian or Pacific Islander
M
American Indian / Alaska Native Female
Female
H
Two or More Races Male
N
Two or More Races Female
DEFINITIONS
A&B. Hispanic or Latino: a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of
race.
C&I. WHITE (Not Hispanic or Latino): a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
D&J. Black or African American (Not Hispanic or Latino): a person having origins in any of the black racial groups of Africa.
E&K. Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino): a person having origins in any of the original peoples of Hawaii, Guam,
Samoa, or other Pacific Islands.
F&L. Asian (Not Hispanic or Latino): a person having origins in any other original peoples of the Far East, Southeast Asia, or the Indian subconti-
nent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
G&M. American Indian or Alaska Native (Not Hispanic or Latino): a person having origins in any of the original peoples of North and South Amer-
ica (including Central America) and who maintains tribal affiliation or community attachment.
.
H&N. Two or More Races (Not Hispanic or Latino): all persons who identify with more than one of the above five races
VETERAN AND DISABILITY STATUS
VETERAN STATUS (refer to definitions below—Check all that apply)
A.
Non-Veteran
B.
I Do Not Wish to Identify Veteran/Disabled Veteran Status
C.
a/ Recently Separated Veteran- within 36 months of discharge. Discharge Date Required: ________________
D.
b/ Armed Forces Service Medal Veteran
E.
c/ Other Protected Veteran
F.
d/ Disabled Veteran
______________________________________________________________________________________________
DISABILITY STATUS (refer to definition below—Check one)
A.
**/ Individual with disability
B.
Not disabled
C.
I do not wish to identify disability status
DEFINITIONS
a/ Recently Separated Veteran (3
years):
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.
b/ Armed Forces Service Medal Veteran: any 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.
c/ Other Protected
Veteran:
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 Dept of Defense.
d/ Disabled
Veteran:
(1) 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 (2) a
person who was discharged or released from active duty because of a service-connected disability.
________________________________________________________________________________________________________________
**/Individual with a
disability:
any person who (1) has a physical or mental impairment which substantially limits one or more of such
person's major life activities; (2) has a record of such an impairment; or (3) is regarded as having such an impairment.
Acceptance Documents
4 of 7
Revised 10/2009
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