INVITATION TO SELF-IDENTIFY This employer is a Government contractor subject to Executive Order 11246, as amended. In accordance with the Executive Order, we will not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. This order also requires Government contractors to take affirmative action to ensure that applicants are employed without regard to their race, color, religion, sex, or national origin. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. Information you submit will be kept confidential, except the Government officials engaged in enforcing laws administered by OFCCP may be informed. This information provided would be used only in ways that are not inconsistent with Executive Order 11246, as amended. I IDENTIFY MYSELF AS: VETERAN OF THE VIETNAM ERA OR ANY OTHER VETERAN WHO SERVED ON ACTIVE DUTY DURING A WAR OR IN A CAMPAIGN OR EXPEDITION FOR WHICH A CAMPAIGN BADGE HAS BEEN AUTHORIZED: A person who: (a) served on active duty for more than 180 days, any part of which occurred between August 5, 1964; and May 7, 1975, and was discharged or released there from with other than a dishonorable discharge; or (b) was discharged from active duty for a service-connected disability if any of such active duty was performed between August 5, 1964, and May 7, 1975; or (c) served on active duty for more than 180 days, any part of which occurred in the Republic of Vietnam between February 28, 1961, and May 7, 1975, and was discharged or released there from with other than a dishonorable discharge; or (d) served on active duty during a war or in a campaign or expedition for which a campaign badge was authorized. YES NO Male Female White African American Hispanic Asian or Pacific Islander American Indian or Alaskan Native Name: _______________________________________ Signature: ____________________________________ Date: ________________________________________