PA-6: Equal Employment Opportunity Data Reporting Form
Please print or type all information.
(Rev. 7/2009)
Golden Gate University takes seriously its commitment to equal opportunity in employment. Each
year, GGU provides a count of University employees by job category and then by ethnicity, race
and gender – called the “EEO-1 Report” – to the Equal Employment Opportunity Commission
(EEOC), the government agency that is responsible for regulating discrimination and harassment in
the workplace.
All employees are requested to voluntarily self-identify their race/ethnicity and gender so that this
information may be collected and accurately reported. If you do not provide this information, the
HR department will make the designation for you based on records or visual identification. Please
complete this form promptly and return it to Human Resources. Thank you.
1. Employee’s Name ___________________________________________________________
(Last, First, Middle)
2. Social Security Number _______________________________________
3. Gender:
Male Female
4. Would you describe your ethnicity as Latino or Hispanic?
Yes No
5. Please check the box that best describes your racial heritage:
A.
Black or African American D. Native Hawaiian or other Pacific Islander
B.
American Indian or Alaska Native E. White
C.
Asian F. Two or more races
6. Please check the method of identification:
Self-identification
Records or visual identification
SIGNATURES
Employee ____________________________________________ Date _____________________
Human Resources _____________________________________ Date _____________________
(if identification performed through reference to records or visual identification)
