Old Form 164

EQUAL EMPLOYMENT OPPORTUNITY COMMISSION

APPROVED BY
OMB
3046-0008

STATE AND LOCAL GOVERNMENT INFORMATION (EEO-4)
EXCLUDE SCHOOL SYSTEMS AND EDUCATIONAL INSTITUTIONS
(Read attached instructions prior to completing this form)
DO NOT ALTER INFORMATION PRINTED IN THIS BOX

EXPIRES
12/31/2005

MAIL COMPLETED
FORM TO:
EEO-4 Reporting Center
PO Box 8127
Reston VA 20195

A. TYPE OF GOVERNMENT (Check one box only)

1. State

2. County

3. City

4. Township

5. Special District

6. Other (Specify)___________________________________________________________________________

B. IDENTIFICATION

1. NAME OF POLITICAL JURISDICTION (If same as label, skip to Item C)

2. Address--Number and Street

CITY/TOWN

COUNTY

STATE/ZIP

EEOC USE
ONLY
A

B

C. FUNCTION
(Check one box to indicate the function(s) for which this form is being submitted. Data should be reported for all
departments and agencies in your government covered by the function(s) indicated. If you cannot supply the data for
every agency within the function(s) attach a list showing name and address of agencies whose data are not included.)
8. HEALTH. Provision of public health
1.Financial Administration. Tax billing and
services, outpatient clinics, visiting nurses,
collection, budgeting, purchasing, central
food and sanitary inspections, mental health,
accounting and similar financial administration
alcohol rehabilitation service, etc.
carried on by a treasurer's, auditor's or
comptroller's office and

GENERAL CONTROL. Duties usually performed by
boards of supervisors or commissioners, central
administration offices and agencies, central
personnel or planning agencies, all judicial offices
and employees (judges, magistrates, bailiffs, etc.)
2. STREETS AND HIGHWAYS. Maintenance,
repair, construction and administration of streets,
alleys, sidewalks, roads, highways and bridges.
3. PUBLIC WELFARE. Maintenance of homes and
other institutions for the needy; administration of
public assistance. (Hospitals and sanatoriums
should be reported as item7.)
4. POLICE PROTECTION. Duties of a police
department sheriff's, constable's, coroner's office,
etc., including technical and clerical employees
engaged in police activities.

5. FIRE PROTECTION. Duties of the uniformed fire
force and clerical employees. (Report any forest
fire protection activities as item 6.)
6. NATURAL RESOURCES. Agriculture, forestry, forest
fire protection, irrigation drainage, flood control, etc.,
and
PARKS AND RECREATION. Provision, maintenance
and operation of parks, playgrounds, swimming pools,
auditoriums, museums, marinas, zoos, etc.
7. HOSPITALS AND SANATORIUMS. Operation and
maintenance of institutions for inpatient medical care.

EEOC FORM 164 FEB 97 (Previous Editions are Obsolete)

9. HOUSING. Code enforcement, low rent
public housing, fair housing ordinance
enforcement, housing for elderly, housing
rehabilitation, rent control.

10. COMMUNITY DEVELOPMENT. Planning,
zoning, land development, open space,
beautification, preservation.

11. CORRECTIONS. Jails, reformatories,
detention homes, halfway houses, prisons,
parole and probation activities

12. UTILITIES AND TRANSPORTATION.
Includes water supply, electric power, transit,
gas, airports, water transportation and
terminals.
13. SANITATION AND SEWAGE. Street
cleaning, garbage and refuse collection and
disposal. Provision, maintenance and
operation of sanitary and storm sewer
systems and sewage disposal plants.
14. EMPLOYMENT SECURITY STATE
GOVERNMENTS ONLY

15. OTHER (Specify on Page Four)

PAGE 1

D. EMPLOYMENT DATA AS OF JUNE 30 
(Do not include elected/appointed officials.  Blanks will be counted as zero) 
1. FULL­TIME EMPLOYEES (Temporary employees are not included) 
MALE 
ANNUAL 
SALARY 
(In thousands 
000) 

NON­HISPANIC 
ORIGIN 
TOTAL 
(COLUMNS B­K) 

WHITE 

Black 

A 

B 

C 

AMERICAN 
ASIAN 
INDIAN 
OR 
OR 
PACIFIC  ALASKAN 
HISPANIC  ISLANDER  NATIVE 

FEMALE 

NON­HISPANIC 
ORIGIN 

White 

Black 

AMERICAN 
ASIAN 
INDIAN 
OR 
OR 
PACIFIC  ALASKAN 
HISPANIC  ISLANDER  NATIVE 

D 

E 

F 

G 

H 

I 

J 

      PAGE 2

K 

1. $0.1­15.9 

2. 16.0­19.9 

3. 20.0­24.9 

4. 25.0­32.9 

5. 33.0­42.9 

6. 43.0­54.9 

7. 55.0­69.9 

8. 70.0 PLUS 

9. $0.1­15.9 

10. 16.0­19.9 

11. 20.0­24.9 

12. 25.0­32.9 

13. 33.0­42.9 

14. 43.0­54.9 

15. 55.0­69.9 
16. 70.0 PLUS 

17. $0.1­15.9 

18. 16.0­19.9 
19. 20.0­24.9 
20. 25.0­32.9 
21. 33.0­42.9 
22. 43.0­54.9 
23. 55.0­69.9 
24. 70.0 PLUS 
25. $0.1­15.9 
26. 16.0­19.9 
27. 20.0­24.9 
28. 25.0­32.9 
29. 33.0­42.9 
30. 43.0­54.9 
31. 55.0­69.9 
32. 70.0 PLUS 
33. $0.1­15.9 
34. 16.0­19.9 
35. 20.0­24.9 
36. 25.0­32.9 
37. 33.0­42.9 
38. 43.0­54.9 
39. 55.0­69.9 
40. 70.0 PLUS 
41. $0.1­15.9 
42. 16.0­19.9 
43. 20.0­24.9 
44. 25.0­32.9 
45. 33.0­42.9 
46. 43.0­54.9 
47. 55.0­69.9 
48. 70.0 PLUS 

EEEEOC FORM 164, FEB 97 (Previous Editions are Obsolete)   

D. EMPLOYMENT DATA AS OF JUNE 30 (Cont.) 
(Do not include elected/appointed officials.  Blanks will be counted as zero) 
1. FULL­TIME EMPLOYEES (Temporary employees are not included) 

MALE 
ANNUAL 
SALARY 
(In thousands 
000) 

NON­HISPANIC 
ORIGIN 
TOTAL 
(COLUMNS B­ 
K)

WHITE 

Black 

A 

B 

C 

FEMALE 

AMERICAN 
ASIAN 
INDIAN 
OR 
OR 
PACIFIC  ALASKAN 
HISPANIC  ISLANDER  NATIVE 

D 

E 

F 

NON­HISPANIC 
ORIGIN 

White 

Black 

G 

H 

AMERICAN 
ASIAN 
INDIAN 
OR 
OR 
PACIFIC  ALASKAN 
HISPANIC  ISLANDER  NATIVE 

I 

J 

K 

49. $0.1­15.9 

50. 16.0­19.9 

51. 20.0­24.9 

52. 25.0­32.9 

53. 33.0­42.9 

54. 43.0­54.9 

55. 55.0­69.9 

56. 70.0 PLUS 

57. $0.1­15.9 

58. 16.0­19.9 

59. 20.0­24.9 

60. 25.0­32.9 

61. 33.0­42.9 

62. 43.0­54.9 

63. 55.0­69.9 
64. 70.0 PLUS 

65. TOTAL FULL TIME 
(LINES 1 – 64) 

2. OTHER THAN FULL­TIME EMPLOYEES (Including temporary employees 
66. OFFICIALS/ADMIN 
67. PROFESSIONALS 
68. TECHNICIANS 
69. PROTECTIVE SERVICE 
70. PARA­PROFESSIONAL 
71. ADMIN. SUPPORT 
72. SKILLED CRAFT 
73. SERVICE/MAINTENANCE 
74. TOTAL OTHER THAN 
FULL TIME 
(LINES 66 – 73) 

3. NEW HIRES DURING FISCAL YEAR ­ Permanent full time only JULY 1 – JUNE 30 
75. OFFICIALS/ADMIN 
76. PROFESSIONALS 
77. TECHNICIANS 
78. PROTECTIVE SERVICE 
79. PARA­PROFESSIONAL 
80. ADMIN. SUPPORT 
81. SKILLED CRAFT 
82. SERVICE/MAINTENANCE 
83. TOTAL NEW HIRES 
(LINES 75 – 82) 

EEEEOC FORM 164, FEB 97 (Previous Editions are Obsolete)   

      PAGE 3

REMARKS (List National Crime Information Center (NCIC) number 
assigned to any Criminal Justice Agencies whose data 
are included in this report) 

***LIST AGENCIES INCLUDED ON THIS FORM*** 

CERTIFICATION.  I certify that the information given in this report is correct and true to the best of my knowledge and was reported in 
accordance with accompanying instructions. (Willfully false statements on this report are punishable by law, US Code, Title 18, Section 
1001.) 

NAME OF PERSON TO CONTACT REGARDING THIS FORM 

TITLE 

ADDRESS (Number and Street, City, State, Zip Code) 

TELEPHONE NUMBER 
extension: 

DATE 

FAX NUMBER 
TYPED NAME/TITLE OF AUTHORIZED OFFICIAL 

SIGNATURE 

E­MAIL 

EEOC  FORM 164, FEB 97 (Previous Editions Obsolete) 

       PAGE 4