Fillable Agency Workforce Report (Illinois Secretary of State)

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Agency Workforce Report (Illinois Secretary of State)

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BROWSE ILLINOIS SECRETARY OF STATE FORMS

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CERTIFICATION
I certify that the information contained in this report is accurate. __________________________________________________________________________
Printed name and title of signatory
__________________________________________________________________________ __________________________________________________________________________
Authorized Signature of official responsible for reporting Date Printed name of agency
INCOME
$ 0 - $ 9,999
$10,000 - $19,999
$20,000 - $29,999
$30,000 - $39,999
$40,000 - $49,999
$50,000 - $59,999
$60,000 - $69,999
$70,000 - $79,999
$80,000 - $99,999
$100,000+
TOTAL
Employees
Professional
Contractual
Position Openings
Openings Filled—New Hires
Openings Filled—Promotions
Agency Workforce Report
Fiscal Year 2019 Agency: _________________________________________
Sent To: Secretary of State, Index Department
111 E. Monroe St., Springfield, IL 62756
Total Number
of Agency
Employees
A copy of this report also must be filed with Office of the Governor.
Printed by authority of the State of Illinois. November 2019 - 220 - I 164.19
Females
No. / %
Minorities
No. / %
Black or
African
American
Males
No. / %
Black or
African
American
Females
No. / %
Hispanic
or
Latino
Males
No. / %
Hispanic
or
Latino
Females
No. / %
Asian
Males
No. / %
Asian
Females
No. / %
American
Indian or
Alaska Native
Males
No. / %
American
Indian or
Alaska Native
Females
No. / %
Native
Hawaiian or
other Pacific
Islander
Males
No. / %
Native
Hawaiian or
other Pacific
Islander
Females
No. / %
Caucasian
Males
No. / %
Caucasian
Females
No. / %
Males with
Physical
Disabilities
No. / %
Females with
Physical
Disabilities
No. / %
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NOTICE TO PERSON COMPLETING FORM
The Secretary of State is the filing agent for these reports and is not authorized to provide legal
interpretations regarding any aspect of the State Employment Records Act, including the defini-
tions below. All questions regarding applicable reporting requirements should be referred to the
legal counsel for your agency or the Illinois Attorney General’s office.
(5 ILCS 410)
Please note that all State agencies shall make the reports by this Act using the forms developed under this
subsection. The reports must be certified and signed by an official of the agency who is responsible for the
information provided. Agencies shall file, as public information and by January 1 of each year, a copy of all
reports required by the State Employment Records Act with the Secretary of State Index Department.
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Agency Workforce Report (Illinois Secretary of State)

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Completed 28 August 2020

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