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EEO Self-Identification Form

EEO Self-Identification Form

EEO SELF-IDENTIFICATION FORM

Equal Employment Opportunity Data Collection

Employer: [Employer Name]

Return completed form to: [HR Contact Name]

Date: [Form Date]

IMPORTANT NOTICE — PLEASE READ BEFORE COMPLETING

[Employer Name] is an Equal Opportunity Employer. To help us comply with federal and state Equal Employment Opportunity (EEO) reporting requirements, we invite you to voluntarily provide the demographic information below.

VOLUNTARY: Completion of this form is entirely voluntary. Your decision to provide or not provide this information will not affect your employment, your compensation, or any other terms or conditions of your employment.

CONFIDENTIAL: The information you provide will be kept strictly confidential and stored separately from your personnel file. It will be used solely for EEO reporting purposes and will not be provided to supervisors or managers involved in employment decisions.

If you choose not to complete this form, we may, as a last resort, use observer identification for reporting purposes only.

EMPLOYEE / APPLICANT INFORMATION

Name: [Employee Name]

Employee/Applicant ID: [Employee ID]

Job Title / Position: [Job Title]

Department / Location: [Department]

SECTION 1 — ETHNICITY

Are you Hispanic or Latino? (Please select one)

[Ethnicity Selection]

SECTION 2 — RACE

Regardless of your answer in Section 1, please identify your race below. (Please select one)

[Race Selection]

SECTION 3 — GENDER

[Gender Selection]

SECTION 4 — VETERAN STATUS (VEVRAA)

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

[Veteran Status]

SECTION 5 — DISABILITY STATUS (SECTION 503 / ADA)

As a government contractor subject to Section 503 of the Rehabilitation Act of 1973, we are required to invite employees and applicants to self-identify as individuals with disabilities. A disability is defined as a physical or mental impairment that substantially limits one or more major life activities.

[Disability Status]

CERTIFICATION

By signing below, I certify that the information I have provided on this form is accurate to the best of my knowledge. I understand that completion of this form is voluntary and that my responses will be kept confidential and used solely for EEO reporting purposes.

Signature: _______________________________ Date: _______________

Printed Name: [Employee Name]

Employee / Applicant

________________

Signature

Maintained by Vladislav Sergienko, Founder·Template last modified: ·Report an error

What Is a EEO Self-Identification Form?

An EEO Self-Identification Form in the United States captures the structured information needed to complete the process it supports.

The EEOC requires private employers with 100 or more employees, and federal contractors with 50 or more employees and contracts of $50,000 or more, to file the EEO-1 Component 1 report annually. The EEO-1 report categorizes the workforce by race/ethnicity, sex, and EEO-1 job category (Executive/Senior Level Officials and Managers, First/Mid-Level Officials and Managers, Professionals, Technicians, Sales Workers, Administrative Support Workers, Craft Workers, Operatives, Laborers and Helpers, and Service Workers). The race and ethnicity categories used in the EEO-1 report — adopted by the EEOC effective 2007 in alignment with OMB Statistical Policy Directive 15 — are: 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); and Two or More Races (not Hispanic or Latino).

Federal contractors subject to VEVRAA must annually invite each applicant and employee to self-identify their veteran status using the categories prescribed by the OFCCP: Disabled Veteran, Recently Separated Veteran (within three years of discharge), Active Duty Wartime or Campaign Badge Veteran, and Armed Forces Service Medal Veteran. Federal contractors subject to Section 503 of the Rehabilitation Act must invite employees and pre-offer applicants to self-identify disability status using the OFCCP's prescribed form (CC-305), which lists examples of qualifying disabilities including autism, cancer, cerebral palsy, deafness, epilepsy, HIV/AIDS, mobility impairments, PTSD, and visual impairments.

The EEO Self-Identification Form differs from a medical examination or disability-related inquiry: it is a voluntary disclosure that cannot be used in employment decision-making and must be maintained in a confidential file separate from general personnel records. The ADA (42 U.S.C. § 12112(d)(3)) imposes strict confidentiality requirements on all medical and disability-related information obtained from employees, requiring that such records be kept in separate, locked files accessible only to designated personnel with a specific need to know.

When Do You Need a EEO Self-Identification Form?

An EEO Self-Identification Form is needed at the hiring stage for all covered employers and federal contractors, and should also be offered periodically to existing employees to confirm accurate workforce data.

Pre-offer or post-offer EEO data collection occurs for federal contractors at the post-offer stage (after a conditional offer of employment has been extended) for disability identification under OFCCP's Section 503 regulations at 41 C.F.R. § 60-741.42. VEVRAA-covered contractors must invite applicants to self-identify veteran status at the pre-offer stage under 41 C.F.R. § 60-300.42. Race, ethnicity, and sex data may be collected at the application stage for EEO-1 reporting purposes, provided the data is maintained in a separate data system from the hiring decision.

Annual EEO-1 reporting requires covered employers to report workforce data as of a workforce snapshot date between October 1 and December 31. To confirm accurate EEO-1 submissions, employers should have self-identification forms on file for all employees and use visual observation only as a last resort when employees decline to self-identify — the EEOC permits visual identification but prefers self-identification for accuracy.

Affirmative action plan (AAP) development requires OFCCP-covered contractors to analyze their workforce by race, sex, and disability status to identify underutilization of protected groups relative to availability in the relevant labor market. Accurate self-identification data is the foundation for a defensible AAP. OFCCP compliance evaluations — desk audits and on-site reviews — specifically examine whether contractors have properly invited self-identification and maintained appropriate records.

Diversity, equity, and inclusion (DEI) reporting for ESG purposes drives voluntary EEO self-identification programs at companies not legally required to file EEO-1. Many S&P 500 companies now disclose workforce diversity metrics in annual ESG or sustainability reports, and institutional investors — including BlackRock, Vanguard, and State Street — have called for such disclosures as part of their proxy voting policies on human capital management.

What to Include in Your EEO Self-Identification Form

A legally compliant EEO Self-Identification Form must contain specific elements to satisfy EEOC and OFCCP requirements while protecting employee privacy and ensuring that data is used only for its intended compliance purpose.

Voluntariness statement: The form must prominently state that completion is voluntary, that refusal to provide the requested information will not subject the employee or applicant to any adverse employment action, and that the information will not be used in any employment decision. This statement is a mandatory requirement of EEOC guidance and OFCCP regulations.

Confidentiality disclosure: The form must state that the information provided will be kept confidential, maintained in a separate file from the employee's general personnel record, and used only for EEO reporting and compliance purposes. For disability-related information, the ADA (42 U.S.C. § 12112(d)(3)(B)) mandates that records be treated as confidential medical records, accessible only to supervisors who need to know about work restrictions, first aid and safety personnel in the event of an emergency, and government officials investigating ADA compliance.

Race and ethnicity categories: The form must use the seven OMB-aligned EEOC categories: Hispanic or Latino; White; Black or African American; Native Hawaiian or Other Pacific Islander; Asian; American Indian or Alaska Native; and Two or More Races. All categories must be presented consistently with the EEO-1 Component 1 report format. The form should not use subcategories that differ from OMB standards unless the employer also maintains an OMB-compliant mapping for reporting purposes.

Sex/gender identification: The EEO-1 report currently uses binary Male/Female categories for Component 1 reporting, though the EEOC has been developing updated categories to reflect nonbinary identities. The self-identification form should offer at minimum the two EEO-1 reporting categories and ideally a non-binary or prefer-not-to-disclose option for employees who do not identify within the binary framework, with internal mapping protocols for EEO-1 aggregation.

Veteran status categories (VEVRAA): For federal contractors, the form must include OFCCP-prescribed veteran status categories: Disabled Veteran; Recently Separated Veteran (within three years of discharge or release from active duty); Active Duty Wartime or Campaign Badge Veteran; Armed Forces Service Medal Veteran; Not a protected veteran; and I do not wish to disclose my veteran status.

Disability identification (Section 503): For federal contractors, the OFCCP's CC-305 form must be used, or a substantially equivalent form, which provides a list of examples of qualifying disabilities and asks the employee to self-identify as: Yes, I have a disability (or previously had a disability); No, I do not have a disability; or I do not want to answer. The form must be re-offered to employees at five-year intervals and must also be offered annually to remind employees they may update their status.

Data retention: EEO self-identification forms must be retained for a minimum of one year after the date the form was created or after the employment action to which it relates, whichever is later, under EEOC regulations at 29 C.F.R. § 1602.14. Federal contractors must retain records for two years under 41 C.F.R. § 60-1.12.

Sources & Citations

Statutory citations link to official government sources.

  1. 42 U.S.C. § 12112US – Cornell LII
  2. 41 C.F.R. § 60US – eCFR
  3. 29 C.F.R. § 1602.14US – eCFR
  4. ADAUS – Cornell LII

Cite this page

Reference this free template in an article, syllabus, or research note:

APA

Forms Legal. (2026). EEO Self-Identification Form (United States) [Legal document template]. Forms Legal. https://forms-legal.com/usa/employment/hr-forms/eeo-self-identification-form

MLA

"EEO Self-Identification Form (United States)." Forms Legal, 2026, https://forms-legal.com/usa/employment/hr-forms/eeo-self-identification-form.

BibTeX
@misc{formslegal-eeo-self-identification-form,
  author       = {{Forms Legal}},
  title        = {EEO Self-Identification Form (United States)},
  year         = {2026},
  howpublished = {\url{https://forms-legal.com/usa/employment/hr-forms/eeo-self-identification-form}},
  note         = {Free legal document template. Based on Fair Labor Standards Act (29 U.S.C. §201-219)}
}

Frequently Asked Questions

Based on Fair Labor Standards Act (29 U.S.C. §201-219) — Template last modified June 2026Verify the source →

This template is provided for informational purposes only and does not constitute legal advice. Laws vary by jurisdiction and change over time. Consult a qualified attorney for advice specific to your situation.Full disclaimer

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