VOLUNTARY SURVEY: Self Identification

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* 1. Race:
The City of Morgantown is committed to providing equal employment opportunities and promoting diversity in the workforce and is also subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to support these goals and requirements, we invite employees to voluntarily self-identify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential to the extent possible and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. Data reported by the City will not identify any specific individual, and the City will protect individual records from disclosure to the extent permitted by law.

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish
culture or origin regardless of race.

White: A person having origins in any of the original peoples of Europe, the Middle East, or
North Africa.

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

Native Hawaiian or Pacific Islander: A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific
Islands.

Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or
the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea,
Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Native American or Alaskan Native: A person having origins in any of the original peoples of North and South America
(including Central America), and who maintain tribal affiliation or community
attachment.

Two or More Races: All persons who identify with more than one of the above five races.

Prefer not to Respond: All persons who decline to provide information.

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* 2. Gender:

Male

Female

Transgender

Non-binary

I prefer not to answer.

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* 3. Disability:
To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. How do you know if you have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: Blindness, Deafness, Cancer, Diabetes, Epilepsy, Autism, Cerebral palsy, HIV/AIDS, Schizophrenia, Muscular dystrophy Bipolar disorder, Major depression, Multiple sclerosis (MS), Missing limbs or partially missing limbs, Post-traumatic stress disorder (PTSD,) Obsessive compulsive disorder Impairments requiring the use of a wheelchair, Intellectual disability (previously called mental retardation)

Yes, I have a disability (or previously had a disability)

No, I do not have a disability

I do not wish to answer

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* 4. Veteran:
If you believe you belong to any of the categories of protected veterans listed below, please indicate by checking the appropriate box below.

I identify as one or more of the classifications of protected veteran listed below.

A “disabled veteran” is one of the following:
-a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt
of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans
Affairs; or
-a person who was discharged or released from active duty because of a service-connected disability.

A “recently separated veteran” means any veteran during the three-year period beginning on the date of such
veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military,
ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been
authorized under the laws administered by the Department of Defense.

An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military,
ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal
was awarded pursuant to Executive Order 12985.

I am not a protected veteran.

VOLUNTARY SURVEY: Self Identification

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* 2. Gender:

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* 4. Veteran:If you believe you belong to any of the categories of protected veterans listed below, please indicate by checking the appropriate box below.

* 4. Veteran:
If you believe you belong to any of the categories of protected veterans listed below, please indicate by checking the appropriate box below.