Form SF 100 SF 100 EEO-1 Employer Information Report

•

•

Joint Reporting
Committee
Equal Employment
Opportunity Commission
Office of Federal
Contract Compliance Programs (Labor)

EQUAL EMPLOYMENT OPPORTUNITY
EMPLOYER INFORMATION REPORT EEO-1

Standard Form 100

REV. 0112006
O.M.B.NO.3048-0007
FORM APpROVAL: www.reglnfo.90v/publlc:/do/PRAHaln
100-214

Refer to instructions for number
1. Indicate by marking in the appropriate box the type of reporting unit for
ONE BOX).
(1) 0

Single-establishment Employer Report
(Required)
Report (submit one for each
or more employees)

OFFICE

USE

Y

Address (Number and street)
or town

c.
2. Establishment tOJ:.wl:1.lch

a.
d.

e.

b.

f.

this establishment last

DYes DNa

C-EMPLOYERS WHO ARE REQUIRED TO FILE (To be answered by all employers)
DYes
DYes

0 No

1. Does the entire company have at least 100 employees in the payrOll period for which you are reporting?
2. Is your company affiliated through common ownership and/or centralized management with other entities
in an enterprise with a total employment of 100 or more?
DYes
0 No
3. Does the company or any of its establishments (a) have 50 or more employees AND (b) is not exempt
as provided by 41 CFR 60-1.5, AND either (1) is a prime government contractor or first-tier subcontactor,
and has a contract, subcontract. or purchase order amounting to $50,000 or more, or (2) serves as a
depository of Government funds in any amount or is a financial institution which is an issuing and paying
agent for U.S. Savings Bonds and Savings Notes?
If the response to question C-3 is yes, please enter your Dun and Bradstreet identification number (if you
'-------haveone):
0 No

I I I I I I I I I I

NOTE: If the answer is yes to questions 1, 2, or 3, complete the entire form, otherwise skip to Section G.

SF 100 - Page 2

Section D-EMPLOYMENT DATA
Employment at this establishment - Report all permanent full- and part-time employees including apprentices and on-the-job trainees unless speciJically excluded as set forth in the instructions. Enter the appropriate figures on aIIlines
and in all columns. Blank ~ces will be considered as zeros.
Number of Employees
(Report employees in only one category)
Race/Ethnicity

Job
Categories

~~M~'{;~:~,

~,

,;;,,;iiatino

.

~
~,

Female

.

Not-Hispanic or Latino

>~

~$[:~,
'{~ite

,.

Black or
African

Native

Asian

Hawalian

Aamerican

Indian or
Alaska
NatiVe

or

American

.< ;:;,

Other

While

Two
or

Black or
African

B

Native

Asian

or

Other

American
Indian or
Alaska
Native

Two

or

mor~

races

Pacific

Islander
F

I

H

G

I

J

K

L

M

N

a

tift

I

1.1
"~f;Y

First/Mid-Level Officials and Managers

Col

A·N

Hawaiian

American

more
races

Pacific
15lander
A

Executive/Senior Level Officials and
Managers

Tolal
Female

Male

1.2

I

Professionals

2

Technicians

3

Sales Workers

4

Administrative Support Workers

5

Craft Workers

6

Operatives

7

Laborers and Helpers

8

Service Workers

9

TOTAL

10

PREVIOUS YEAR TOTAL

11

lit:

/:<:j~~~:t;, '

h~ t:~;::>/ ;~~:JV

~

<: ~::;:'

{:j:l'::c,:/>'

~

~

Al~
,ifi~9:
~

>A:~f.Y
:;;: ~~:,'

': /x'
:::~;.

.<:::~lZ~; -/

1. Date(s) of payroll period used:

(Omit on the

?::::;~~~:;:.

Consolidate~:~~~.)

Section E - ESTABLISHMENT INFORMATION (O!!li~:Wti the Consolidated Re~~.t:"
4<{1)/''''': .

1.

'":~~;;J>"

,,~~?~?:~<

~"/x!>?:~

What is the major activity of this establishment? (Be specific, i.e., manufacturing steel castings, re't~.f~,()cer, wholesaltzilt~~ing suppIl~$t1JJ:le insurance, etc.
Include the specific type of product or type of service provided, as well as the principal business or iiif!ti~ial activi~)?:> >";;;~~;:::;.
~"
9~~;~~~;;~~~,~

Section G - CERTIFICATION

Rep&~~ruy.)
one

2

0

This report is accurate and was prepared in accordance with the instructions.

-r

Name of Certifying Official

TItle

Signature

Name of person to contact regarding this report

Title

Address (Number and Street)

City and State

Zip Code

1

TelePhone No. (including Area Code and
Extension)

Date

1

All reports and information obtained from individual reports will be kept confidential as required by Section 709(e) of TItle Yll.
WILlfULLY fALSE STATEMENTS ON THIS REPORT ARE PUNISHABLE BY LAW, U.S. CODE, TITLE 18, SECTION 1001

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