Form 274 LOCAL UNION REPORT (EEO-3)

Union Reporting Program
Washington, DC 20507

Approved by
OMB No. 30460006
Expires: XX/2020

EQUAL EMPLOYMENT OPPORTUNITY
LOCAL UNION REPORT (EEO-3)

Part A. LOCAL UNION IDENTIFICATION
b. Union office, if different from 2a.

1. Full name of local union for which this report is filed. (Include local number,
if any.)

Number and street
City
2. Mailing address.

County

a. Where official mail should be sent to the union.

State

Zip Code

3. Indicate type of local union report by a check in applicable box:

Number and street

a.
b.

City

Report filed by local union in its own behalf
Other (explain)

4a. Are you affiliated with or chartered by a national or international union
or national federation?
Yes
No

County

b.

State

If “Yes” to item 4a, give name and address of such national or international organization.

Zip Code
5. Are you affiliated with the AFL-CIO?

Yes

No

PART B. LOCAL UNIONS REQUIRED TO FILE
1. Has the local union had 100 or more members at any time since December
31 of the preceding year?
2. Does the local union, or any unit, division, or agent of the local union,
or any labor organization which performs, within a specific jurisdiction,
the functions ordinarily performed by a local union, whether or not it is
so designated:
a. Operate a hiring hall or hiring office?
b. Have an arrangement under which one or more employers are required
to consider or hire persons referred by the local union or an agent of
the local union?
c. Have 10 percent or more of its members employed by employers which
customarily and regularly took to the union, or any agent of the union,
for employees to be hired on a casual or temporary basis, for a specified period of time, or for the duration of a specified job?

EEOC FORM 274, REVISED 2014 PREVIOUS EDITIONS ARE OBSOLETE

Yes

No

The union must complete this entire report if it answered “YES” to item
1, AND the answer is “YES” to any of the three questions in item 2.
The union is not required to complete the entire report if it answered “NO”
to item 1, OR “NO” to all three questions in item 2. If that is the case, the
union must complete Parts A, B, and C and return this form to the
specified address.

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PART C. IDENTIFICATION AND SIGNATURE
To the best of my knowledge and belief, the information contained in this report is true and complete. It is further certified that to the extent any data in Schedule I, Items 1 or 2,
are based on self-identification by individuals, this information was gathered only after they were advised of its confidential nature and purposes.
1. Type or print name, title, address and telephone number for union business of designated representative
Name
Title
Work

address

Telephone number (including area code)
2. Signature of designated representative

3. Date

“Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals, or
covers up any trick, scheme, or device a material fact, or makes any false, fictitious or fraudulent statements or representations, or makes or uses
any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than
$10,000 or imprisoned not more than 5 years, or both.” Title 18, Section 1001, United States Code.

SCHEDULE I—LOCAL UNION REPORT (EEO-3)
MEMBERSHIP, APPLICANT and REFERRAL INFORMATION
1. Method of identification

Check all
applicable boxes

How was information as to race/ethic identification and sex in Item 2 below obtained?

a. Existing Record

This information may be obtained by visual survey, from records made after employment, from personal knowledge or by self-identification. The self-identification method
may be used subject to the conditions set forth in the instructions. No State law prohibiting the self-identification method applies, since the Equal Employment Opportunity
Commission’s regulations supersede such laws.

2. Statistics

b. Visual Survey
c. Tally from Personal Knowledge
d. Self-Identification
e. Other (Specify)

RACE/ETHNICITY
NON-HISPANIC OR LATINO

HISPANIC
OR
LATINO

FEMALE

Male

Female

White

Black or African
American

Asian

Native Hawaiian
or Other Pacific
Islander

American Indian
or Alaska
Native

Two or more
races

White

Black or African
American

Asian

Native Hawaiian
or Other Pacific
Islander

American Indian
or Alaska
Native

Two or more
races

MALE

A

B

C

D

E

F

G

H

I

J

K

L

M

N

Total
Col
A--N

O

a. MEMBERSHIP IN
REFERRAL UNIT
(1) MEMBERS
(2) APPLICANTS FOR MEMBERSHIP
DURING THE PAST YEAR
b. REFERRALS DURING 2-MONTH
PERIOD
(1) NUMBER OF PERSONS
REFERRED
(2) NUMBER OF REFERRALS
(3) APPLICANTS FOR REFERRAL

3. Period Used For Referral Date
You should obtain the figures reported in item 2 “Statistics” using any 2-month period between August 1 and November 30.
Dates of 2-month Period
EEOC FORM 274, REVISED 2014 PREVIOUS EDITIONS ARE
OBSOLETE

EEOC ORIGINAL

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