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Appendix A EEO Report Forms This appendix reproduces the four equal employment opportunity (EEO) reports that collect data relevant to wages and employment, dis- cussed in Chapter 1: • EEO-1, required from private employers with 100 or more employ- ees or 50 or more employees and a federal contract; • EEO-3, required from referral unions, primarily unions with exclu- sive hiring arrangements with an employer; • EEO-4, required from state and local governments; and • EEO-5, required from primary and secondary public school districts. 99

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100 COLLECTING COMPENSATION DATA FROM EMPLOYERS A-2

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APPENDIX A 101

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102 COLLECTING COMPENSATION DATA FROM EMPLOYERS A-4

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APPENDIX A 103 A-5

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104 COLLECTING COMPENSATION DATA FROM EMPLOYERS EQUAL EMPLOYMENT OPPORTUNITY COMMISSION  APPROVED BY  OMB  STATE AND LOCAL GOVERNMENT INFORMATION (EEO­4)  3046­0008  EXPIRES  EXCLUDE SCHOOL SYSTEMS AND EDUCATIONAL INSTITUTIONS  12/31/2005  (Read attached instructions prior to completing this form)  DO NOT ALTER INFORMATION PRINTED IN THIS BOX  MAIL COMPLETED  FORM TO:  EEO-4 Reporting Center PO Box 1898 Chicago, IL 60690-1898 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. Address­­Number 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.)  1.Financial Administration.  Tax billing and  8. HEALTH. Provision of public health  collection, budgeting, purchasing, central  services, out­patient clinics, visiting nurses,  accounting and similar financial administration  food and sanitary inspections, mental health,  carried on by a treasurer's, auditor's or  alcohol rehabilitation service, etc.  comptroller's office and  9. HOUSING.  Code enforcement, low rent  GENERAL CONTROL.  Duties usually performed by  public housing, fair housing ordinance  boards of supervisors or commissioners, central  enforcement, housing for elderly, housing  administration offices and agencies, central  rehabilitation, rent control.  personnel or planning agencies, all judicial offices  and employees (judges, magistrates, bailiffs, etc.)  2. STREETS AND HIGHWAYS.  Maintenance,  10. COMMUNITY DEVELOPMENT.  Planning,  repair, construction and administration of streets,  zoning, land development, open space,  alleys, sidewalks, roads, highways and bridges.  beautification, preservation.  3. PUBLIC WELFARE. Maintenance of homes and  11. CORRECTIONS.  Jails, reformatories,  other institutions for the needy; administration of  detention homes, half­way houses, prisons,  public assistance. (Hospitals and sanatoriums  parole and probation activities  should be reported as item7.)  4. POLICE PROTECTION.  Duties of a police  12. UTILITIES AND TRANSPORTATION.  department sheriff's, constable's, coroner's office,  Includes water supply, electric power, transit,  etc., including technical and clerical employees  gas, airports, water transportation and  engaged in police activities.  terminals.  13. SANITATION AND SEWAGE.  Street  5. FIRE PROTECTION.  Duties of the uniformed fire  cleaning, garbage and refuse collection and  force and clerical employees.  (Report any forest  disposal.  Provision, maintenance and  fire protection activities as item 6.)  operation of sanitary and storm sewer  systems and sewage disposal plants.  6. NATURAL RESOURCES. Agriculture, forestry, forest  fire protection, irrigation drainage, flood control, etc.,  and  14. EMPLOYMENT SECURITY STATE  PARKS AND RECREATION.  Provision, maintenance  GOVERNMENTS ONLY  and operation of parks, playgrounds, swimming pools,  auditoriums, museums, marinas, zoos, etc.  7. HOSPITALS AND SANATORIUMS. Operation and  15. OTHER (Specify on Page Four) maintenance of institutions for inpatient medical care.  EEOC FORM 164 FEB 97 (Previous Editions are Obsolete)              PAGE 1 

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APPENDIX A 105 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  FEMALE  AMERICAN  AMERICAN  NON­HISPANIC  ANNUAL  ASIAN  INDIAN  NON­HISPANIC  ASIAN  INDIAN  ORIGIN  OR  OR  SALARY  OR  ORIGIN  OR  TOTAL  PACIFIC  ALASKAN  PACIFIC  ALASKAN  (In thousands  000)  (COLUMNS B­K)  WHITE  Black  HISPANIC  ISLANDER  NATIVE  White  Black  HISPANIC  ISLANDER  NATIVE  A  B  C  D  E  F  G  H  I  J  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)                      PAGE 2

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106 COLLECTING COMPENSATION DATA FROM EMPLOYERS 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  FEMALE  NON­HISPANIC  NON­HISPANIC  AMERICAN  AMERICAN  ORIGIN  ASIAN  ORIGIN  ASIAN  ANNUAL  INDIAN  INDIAN  SALARY  TOTAL  OR  OR  OR  OR  (In thousands  (COLUMNS B­  PACIFIC  ALASKAN  PACIFIC  ALASKAN  000)  K) WHITE  Black  HISPANIC  ISLANDER  NATIVE  White  Black  HISPANIC  ISLANDER  NATIVE  A  B  C  D  E  F  G  H  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

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APPENDIX A 107 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:  FAX NUMBER  DATE  TYPED NAME/TITLE OF AUTHORIZED OFFICIAL  SIGNATURE  E­MAIL  EEOC  FORM 164, FEB 97 (Previous Editions Obsolete)                       PAGE 4

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108 COLLECTING COMPENSATION DATA FROM EMPLOYERS EQUAL EMPLOYMENT OPPORTUNITY COMMISSION FORM APPROVED BY OMB ELEMENTARY-SECONDARY STAFF INFORMATION (EEO-5) NO. 3046-0003 APPROVAL EXPIRES Public school systems This is a joint requirement of the EEOC and the Office for Civil Rights, U.S. Department of Education and the U.S. Department of Justice. DO NOT ALTER INFORMATION PRINTED IN THIS BOX. NOTE: ALL EMPLOYEES IN YOUR SCHOOL DISTRICT MUST BE INCLUDED ON THIS FORM. Additional Copies of this form may be obtained from the address below. Send your full report to: PART I. IDENTIFICATION A. TYPE OF AGENCY WHICH OPERATES THE REPORTING SCHOOL SYSTEM  Local Public School  Special Regional Agency  State Education Agency  Other (Specify) ____________________________________ B. SCHOOLS SYSTEMS IDENTIFICATION (OMIT IS SAME AS LABEL) NAME STREET AND NO. OR POST OFFICE BOX CITY/TOWN COUNTY STATE ZIP C. GENERAL STATISTICS NUMBER OF SCHOOLS OPERATED NUMBER OF ANNEXES OPERATED OCTOBER 1ST ENROLLMENT D. REMARKS EEOC FORM 168A Page 1

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APPENDIX A 109 DO NOT INCLUDE ELECTED/APPOINTED OFFICIALS (SEE DEFINITION IN PART II. Staff Statistics of (DATE) ________________________ APPENDIX) DISTRICT NAME: _______________________________________ A. FULL-TIME STAFF Race/Ethnicity Activity Assignment Hispanic or Non -Hispanic or Latino Classification Latino Total Male Female Col A-N Black or African or Alaska Native American Indian Native Hawaiian American Indian or Other Pacific Two or more Native Hawaiian Black or African Two or more or Other Pacific American or Alaska Islander Female Native White White Asian Asian races Male races American Islander A B C D E F G H I J K L M N O 1. Officials, Administrators, Managers 2. Principals 3. Assistant Principals, Teaching 4. Assistant Principals, Non-teaching 5. Elementary Classroom Teachers 6. Secondary Classroom Teachers 7. Other Classroom Teachers 8. Guidance 9. Psychological 10. Librarians/ Audiovisual Staff 11. Consultants & Supervisors of Instruction 12. Other Professional Staff 13. Teachers Aides 14. Technicians 15. Administrative Support Workers 16. Service Workers 17. Skilled Crafts 18. Laborers and Helpers 19. TOTALS (1-18)

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110 COLLECTING COMPENSATION DATA FROM EMPLOYERS B. PART-TIME STAFF Activity Race/Ethnicity Assignment Classification Hispanic Non -Hispanic or Latino or Latino Male Female Black or African or Alaska Native American Indian Native Hawaiian American Indian Native Hawaiian Black or African or Other Pacific or Other Pacific Two or more Two or more American or Alaska Islander Female Native White White Asian Asian races Male races American Islander 20. Professional Instructional 21. All Other 22. TOTALS (20-21) C. NEW HIRES FULL-TIME (JULY THRU SEPT. OF THE SURVEY YEAR) 23. Officials, Administrators, Managers 24. Principals/Assistant Principals 25. Classroom Teachers 26. Other Professional Staff 27. Nonprofessional Staff 28. TOTALS (23-27) CERTIFICATION: I certify that the information given in this report is correct and true to the best of my knowledge and was prepared in accordance with accompanying instructions. Willfully false statements on this report are punishable by law, U.S. Code, Title 18, Section 1001. Date Phone: Typed Name/Title of Person Responsible for Report Signature Fax: Email: EEOC FORM 168A PREVIOUS EDITIONS ARE OBSOLETE