Equal Employment Opportunity Staffing Plan

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New York State Division of Homeland Security and Emergency Services
LOCAL ASSISTANCE MWBE EQUAL EMPLOYMENT OPPORTUNITY STAFFING PLAN Form B - VENDOR / SUBCONTRACTOR
IMPORTANT: A LOCAL ASSISTANCE MWBE EEO STAFFING PLAN MUST BE SUBMITTED DURING THE PERIOD OF THE CONTRACT IN ORDER TO PROCESS PAYMENTS FOR THE PROJECT. A REVISED LOCAL
ASSISTANCE MWBE EEO STAFFING PLAN MUST BE SUBMITTED WITH ALL BUDGET MODIFICATION REQUESTS. LOCAL ASSISTANCE MBWE STAFFING PLANS ARE REQUIRED FOR ALL GRANTEES AND EACH
SUBCONTRACTOR IDENTIFIED IN THE CONTRACT. PLEASE COMPLETE FORM B FOR EACH SUBCONTRACTOR.
1. Vendor (Subcontractor) Name:
2. DHSES Contract Number:
3. Duns Number:
4. Vendor (Subcontractor) Address:
5. This form indicates the Vendor's / Sub-Contractor's (select one):
Work force to be utilized on this contract
Total work force
6. Date:
7. Federal ID Number:
8. EEO Goal (Vendor/Subcontractor): MBE (Minority)
%
WBE (Women)
%
Enter the total number of employees for each classification in each of the EEO - Job Categories identified: This portion of the form (fields 9-14), is a spreadsheet,
Fields 13 and 14 will automatically calculate when using this feature.
12. Work Force by
10. Work Force
9. Total
by Gender
11. Work Force by Race/Ethnic Identification
Disabled/Veteran
Work
Identification
Force
Identification
by Job
American
Native
EEO-Job Category
Category
Indian or
Black or
Hawaiian or
Total
Total
Alaska
African
Hispanic or
Other Pacific
Two or
Male
Female
Native
Asian
American
Latino
Islander
More Races
White
Disabled
Veteran
(M)
(F)
(M)
(F)
(M)
(F)
(M)
(F)
(M)
(F)
(M)
(F)
(M)
(F)
(M)
(F)
(M)
(F)
(M)
(F)
Craft Workers
Laborers
Office/Clerical
Officials/Administrators
Professionals
Sales Workers
Service Workers
Technicians
Temporary/Apprentices
13. Subtotals:
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
14. Total Workforce:
0
IMPORTANT: EMPLOYEES SHOULD ONLY BE LISTED IN ONLY ONE RACE / ETHNIC IDENTIFICATION CATEGORY.
15. PREPARED BY (Signature):
EMAIL ADDRESS:
PHONE NO.:
DATE:
NAME AND TITLE OF PREPARER (Print or Type):
16. MWBE Liaison:
FOR DHSES USE ONLY
MWBE EEO Staffing Plan Approved
MWBE EEO Staffing Plan Denied
GPA Minority Business Officer:
Review Date:
Reviewer’s Comments:
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