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U S. Office of Personnel Management

ETHNICITY AND RACE IDENTIFICATION

Guide to Personnel Data Standards

(Please read the Privacy Act statement and instructions before completing form.)

Name (Last, First, Middle lnitial)

,ll,l L,

Only
Agency Use^r

[Y\:.1^^*

P\

Birlhdate (Month and Year)

02" o5-

lcl"7 L,

Privacy Act Statement

Ethnicity and race information is requested under the authority of 42 U.S C. Section 2000e-16 and in compliance with
the Offite of Management and Budgets 1997 Revisions to the Standards for the Classification of Federal Data on Race
and Ethnicity RroviOing this informition is voluntary and has no impact on your employment status, but in the instance
of missing information, your employing agency will attempt to identify your race and ethnicity by visual observation.

This information is used as necessary to plan for equal employment opportunity throughout the Federal government. lt
is also used by the U. S. Office of-Personnel Management or employing agency maintaining the records to locate
individuals for personnel research or survey response and in the production of summary descriptive statistics and
analytical studies in support of the function for which the records are collected and maintained, or for related workforce
studies.

Social Security Number (SSN) is requested under the authority of Executive Order 9397, which requires SSN be used
for the prrporb of uniform, orderly administration of personnel records. Providing this information is voluntary and failure
to do so will have no effect on your employment status. lf SSN is not provided, however, other agency sources may be
used to obtain

it.

.rt"r"ti""t fne two questions below are designed to identify your ethnicity and race. Regardless of your answer to
question 1, go to question 2.
Question 1. Are You Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Sp""iti"

Spanish culture or origin, regardless of race.)

fJ ves

No

o*.ategorieswithwhichyoumoStc|ose|yidentifybyplacingan..X,,intheappropriate
box. Check as many as apPly.
RACIAL CATEGORY
(Check as many as apply)

DEFINITION OF CATEGORY

A person having origins in any of the original peoples of North and South America
(including Cential America), and who maintains tribal affiliation or community

American lndian orAlaska Native

attachment.

A person having origins in any of the original peoples of the Far

Eas-t, Southeast

Asia, or the lndian iubcontinent including, for example, Cambodia, China, lndia,
Japan, Korea, Malaysia, Pakistan. the Philippine lslands, Thailand, and Vietnam'

fJ

atack or Africi:n American

A person having origins in any of the black racial groups of Africa

Native Hawaiian or Other Pacific lslander

A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or

wnite

other Pacific lslands

A person having origins in any of the original peoples of Europe, the Middle East, or
North Africa.
Standard Form 181
Revised August 2005
Previous editions not usable

42 U S.C Section 2000e-16

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.\poltgizing fot' tlrt enslilvcurcul and rrrr,ial se3r'cg,atiort rlf ^\1i'it'irrr-,\ttltlt'it'atls.

IN TIIIi IIOI-Si]

OF' IIEI'HI]SIiNT.\'I'IYES

Irulnt',rt?t' :7, 2(X)7

]h' ( l()HnN (toi. ]rirrrself. lIt'. Jttttssor* of (icolgia, Ils. .J-rt'I(srx-l ,I'lIi of
Tcxas. )[r.. I]trnv of Prtrnslt'irttitr, lli'. \YtiXt,l;tt, JIs. Iitt,t'.Lt1tl('Ii, JItj.
\Yool,stir'. f h'. P,rt,l,or*ll. ^\ls. Ltlli. f,Ii'. -\It'(]r .rr-titis. lls. St'II-\K()\\'sli\',
llis. ]I.U,oNIIY of Nel'Yor'li. ]It'. L'ttXrnlls. ,\h'. Jltxitr- of \-irg'iuia. lL'.
('-u,Il^rNo, JIr. R-lrtiEL. lh'. 1'tr-xi;, ]h'. .Itil'l'-cits()\. fll'. Eu,tsos' Jh'.
^\t. (ittlitis o1' 'lcxtrs, lh'. I']t-'t"t'lllii"IELIr, Jis. \\--r'lsltx. llr'. IItxt'tttit,
lfu'. Llt,ti-gr'tl, lls. C-t1stlN. llr. Istl-rg,, Jft'. -\t lilllill.\N, llr'. I)'ryrs r-rf
,\ltrlrarna, JIr. Lnri-ls of (ieot'giit. Jh'. ,\t;nnt'li()llllIFl, lir. FI-rttc. JIr.
Iftixxriov. JIs. I]-u.Irn'ls. ]h'. II<lurs, ]lr'. I"tt,xrin. ][r'. IIoxD^t. atrtl
lh,. I{t't'tsicI{) sullrrittL'rl t}u, fol}rrn"ing lesohrtiorr; l'}ii<'}r rrtts t'cft'ttct1 trr
tlrt, ('ornruittee ott tltt 'Ititliciat'r'

RESOLUTION
Apologizing fbl' the ettslar'('lilt'Ilt itud rilciill scgrty,^ation of
,\frit'irr t-.\ t t ti't'it'tt t s,
t

\\'lrereus tnillions tif -\fi'i<'arrs alld tlreit' clescetttlitttts

erisia\'(.rl iu tirc Uniterl States alxl the 1:l Ameri(rall
nicrs troni 1619 tlu'ougt 1865:

\\-ere

colo-

\\'hereas slrn'er'.r' in r\ntericir l'eselnblecl tto otl)el' fiit'tti of irn-oluutai.\- sela-itu(lc l<noxri iii histor1,, irs Aft'iealls \Ytrre Cal)-

tqi'ccl arrcl sold at auction like inatrituatt' ol-rjt'cts t)l' ill]i.,r.',l.'.

\\'hereas Afrittatrs forcted ittto slttvel'l- \\'ere bmttrlizecl, lrurniliatecl, clehuilanizecl, ancl subjectecl to the inclignitv of
bc'ing stripl.recl of thcit' names aud heritage;
\\-hereets ertsltrr,ecl flzrtnilies \\rere

tonr apart after hitvirrg

beeri

sold sepa,r'ate11' from one auotltei';

\Yht'reas the s)-stt:ttt of slttvt'r1' anrl thtr visceral i'ttcisrn agair-rst
l)ersolIS of l\frit'itti clestrettt tlpoll rvhi<'lr it deperrcled becarne entrenchcd

iil thc Natioil's social fabl'ic;

\\}er.eus sluvetl'x,ttS ttot officialh' abolisherl trlltil the lrassagtl

of' tlte 1 3th ,\nie,ttclmetit to tlle U riited States Llolistitr-rtion in 1865 after thc encl 0f thc cir.il \\'ar, u'ltich $'as
ficlught over tltcr slat'erv issuc;

\Vhereas after emattcilttttioli trorn 246 1-ears tlf slaver"v, African-Americans soorl szt\\. the fleeting' political, social, and
econotuic gains thef inttcle ch'Lring Reconstruction cl'isgerertecl ltt- I'irr--Llerrt racisnr. l1'nchings, clisertfrettltrltisetleitt,

I'rlack Codes, a,nt1 r'acial segrc'gation la$'s that irnposed a

r.igid sl,stem of offlcitrllr- sanctioirccl r'uciul segreg'ation in
r,irtuaLll)' all areas of life:

tltt, st.stt'm rtf cle jlri'e racial scgreg'atiotl litrou'n as

",Iirn (-ro\\,," u'hicli Al'ose in certaiit llarts of the Naticlrl
foll6rr'irrg tlre tlivil \\'ar to t'reitte sepitrate atirl ttttequtrl
societies frir l.ltites atrcl Afi'icarr-Americiltrs, \\'a,s a direct
result of tlie racistu against l)ersons of Afi'ican rlestlertt

\Ylrei'r,as

ettgettclerecl bv sltrr,e$-;

\Vhereas the s1'stem of Jim Crou' lau's officiallv cxisteil iuto

the 1960',s-11 t-rentun' aftci. the official rrncl of slaYcrt' irt
,\tnericit-r-rntil Cotlgress took atltioti to encl it, br-tt tlie
r,estiges of

Jim Crout contitme to this

clal';

\\hereas Africait-Artericans coutimLe to sufft-'r' from the conseqllelt(ies 6f slzs'er1' attd Jirn (ly9rv-l6rrg aftep bgtlr sys.HRES 194 IH

'!

;j

ialh' alrol isl r ed-f l iy1y1loli L.r ronnr iris cla nra ge
and loss, botlr tangible ancl intangible. irrclurlirrg the loss
of' lurnrtrn clignitv ancl libt,rt.r,, the fnrstt'atioir of cilr'(,el's
trntl ltrof'essiorial liles, arrcl tlre Lrrrq'-telni lr;ss of iirconie
and ollltortuuitr-:

tetn s \\'el'e fi lni

ston' of' the (,rlslrlvtlilclrt iiirci clr.jui't. srgrcgiltirxr

of ,\ft'it'rtir-.\tttet'ir.atts itrrrl tlre tlelrrrnriirriziriq atlor.itics
cornnrittrtl agairrst tlrenr shorrkl rlot ])(] l)11]'g1,(1 froni o1'
ririninrizt,d iit tlie telliirg of Arrrerirair historl-;

\\-1rct'eas the

tlill to Lioree Islantl, St,rregal, a fbmrer slavc port, Pi'ttsirleirt Gcoi'ge \\', I']trsh ac-

\Ylrereas oir,Iul.r'8, 200:1. durirrs tr

slulerr,'s corrtirruing' legael- in Anerican lile

arncl the need to r:oritnnrt tlrat leg'ar..r' r\'lierr he staterl tlrat
slalei'r, "\\'as
oltr. of thr: glcatcst crinres of histon.
. The racial bigotr'1, fld liy sliu'cr'.1' c1icl rrot end x,ith
slavei'\' or t-ith seg'regatioti. -\ricl illa]]\, tlf the issues tlrat
stili troulrlc Anc,r'ica hale r,oots iu the bitter. eqter.icnce
of <ttlier tinres. But liol'crr,r' ir-ing' thc ,jouur(r\', otll. cicstinl'
is set: libertr- zrt rrl ,jusl it.e tirr ull. ";
knort'1t'r1gec1

\\'hcrr:as l'r't,sirlent Iiiil (lliiiton also ;rclnrorr'lt,tlgctl the tJcril)seittrtl ploblerrLs tarist'('[ l,lr- tire t.orrtirnrirrg' lt'gac1- of ltrt:isin agairist -\flit.an-,\nrerir.irrrs tlrat heg'arr s-itlr sialen'
n'ltcit hc irritiatccl a national rlitrlogrre alroul ract:
\\-hercas tr genuirie apologr is trn iurl;ortant turcl tiecessrll'\'
first stelt irr tlre 1)r'o(.ess of raciai ret.orrr.iliittiorr;
\Yht'reas art apologt for ccntui'ics of ltnrtal rlcinrmanizatiorr
aricl irljr-Lstices cannot el'itsc the past, but corrlession of
tlte rt'rottgri (:olnrnittetl citn speecl rarriarl lrealitig rur(l re(i-

oirciliation antl hellt ;\rl elicans confront the g'liosts of

thcii' lrast;

\\'lrereas tlre legrslaturc, of the cornnroruleaith of \-ilgirria lras

rccetttlt' tal<eu thc lilatl in adoptirlg' a i.esoiutiorr officiall.r'
ex1,ri'essing tr1;pirllrr.iate r.t:rlror.se for slaYcrl, arrrl other.
State legislatrit'es tlre <'orrsiclerirrg sirrrilar. resohrtierrs; zrrrcl

it is irnlrortalt f'oi' this (,ourrtn'. u'hir,h legally l.(.(1og.rtizeti sltlYt't't' titrotrslt its ('oirstitutiurr airrl its lilu-s, tri
Inill<e it fot'ttrti] apologr' lirr sltn'trv atrrtl firl its su(.(.essol..
,Iir, C.on', lio that it cAlI r)l()\'e f<rrr'anl a*d scrcli r,.conciliation, justice, urirl hai.rrrorn- for. irll of its citizens:

\\'lrercas

Nr)\\,, tlier.efrtr.e, Ite

1
2
3
4
5
6
7
8
9
10
11
12
13

it

Resrl t:etl, That the

(1)

llousc of'lteltr.t,serrtatir.

aclitto,,'lt'dg-t:s

the

hrrrrlutnenttrl injristics.

t't'ttelt.t', llrtittrlit.r', ancl irrlrLrnrarritt'of slan'en'uucl

Jim Cr.ou';

(2)

to Ah'ica,-a,.r.ic.ns oir behalf

,f tlre pe'ple ,f tlre llriterr Sttrtes, firr. tlie \\,l.orlg.s
u1;olo3iztrs

coilnrittctl ag'ainst theru aiirl tlrr,il airceiitsi.s

srrfft,r't,tl rr,r1cr. sl.r-r,r.r- tr.tl

1.1o

,Iiiir (,i,r;*.: tlirri

(jl) t'xlrresses its ('orlirl)itnrerrt to

r.et,tifr- tlre lirr-

3e|ilrg colls('(lit('llces of tlre ruisrlcctls coinurittcrl

agitirist .{h'ican-Air"riruns unclrr slavgf. arrrl Jirrr
Llrrxv arril

tr; stoll tlie

r.iolatiols irr the futur,r:.

.HR-ES 194

III

o(.(,ur.r,L.rI(.e

of lrtrnrurr

r.ig.lrts