EEO SELF IDENTIFICATION FORM

EEO Self Identification Form
  • As part of Menorah Park ‘s affirmative action efforts, we request your cooperation in completing this voluntary identification form which allows us to comply with government requirements for record keeping and periodic reporting of this data. The information you provide will be treated confidential and will be used only in accordance with government reporting requirements. Failure to provide the information requested will not subject you to adverse consideration for the position.
  •   Male
      Female
  •   Hispanic
      Latino
  •   American Indian
      Asian
      Black or African
      Native Hawaiian or other Pacific Islander
      White
  •   Armed Forces Service Medal Veteran
      Recently Separated Veteran
      Other Protected Veteran
  • Menorah Park is an affirmative action/equal employment opportunity employer. Women, minorities, veterans and persons with disabilities are encouraged to apply. The information you provide will be treated confidentially and will be used only in accordance with affirmative action objectives and government reporting requirements.

Ethnicity/Race

Hispanic or Latino:  A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
American Indian or Alaska Native: A person having origins in any of the original peoples of North or South America (including Central America), and who maintains a tribal affiliation or community attachment.
Black or African American: A person having origins in any of the Black racial groups of Africa.
Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia,
or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Veteran Status

Armed Forces Service Medal Veteran means any veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
Other Protected Veteran means a veteran who served on active duty in the U.S. military, ground, naval or air service 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.
Recently Separated Veteran means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval or air service.

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    4101 East Genesee St.
    Syracuse, NY 13214

    315.446.9111