Equal Employment Opportunity

Chipton-Ross is required to collect this information for equal opportunity employment purposes; however, completion of this form is entirely voluntary. Your response, or decision not to respond, will not affect your employment or any employment decision. Information provided will be kept confidential and used only for legally required reporting. If you choose to complete this form, name and email are required.

Full Name *

Email Address *

Gender

Male Female Non‑binary Prefer not to say

Race / Ethnicity (select all that apply)

Hispanic or Latino White (Not Hispanic or Latino) Black or African American (Not Hispanic or Latino) Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) Asian (Not Hispanic or Latino) American Indian or Alaska Native (Not Hispanic or Latino)

Disability Status

Individual with a Disability A person who has a physical or mental impairment that substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such an impairment.

Veteran Status (select all that apply)

Disabled Veteran A veteran entitled to disability compensation under laws administered by the Secretary of Veterans Affairs, or discharged or released from active duty because of a service-connected disability. Veteran of the Vietnam Era A person who served on active duty for more than 180 days with other than a dishonorable discharge, with service in the Republic of Vietnam between Feb. 28, 1961 and May 7, 1975, or elsewhere between Aug. 5, 1964 and May 7, 1975. Recently Separated Veteran Any veteran during the three-year period beginning on the date of discharge or release from active duty in the U.S. military, ground, naval, or air service. Other Protected Veteran A veteran who served on active duty in the U.S. military during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. Armed Forces Service Medal Veteran A veteran who participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 (61 Fed. Reg. 1209).

This form is entirely voluntary. You may leave any or all fields blank.

Equal Employment Opportunity

Employment Opportunity Data

EEO Policy Statement

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