Employee Complaint Investigation

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☐No ☐Yes ☐ (0) White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa ☐ (1) Black or African American (Not Hispanic or Latino) – A person having origins in any of the black racial groups of Africa ☐ (2) Asian (Not Hispanic or Latino) – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent ☐ (3) American Indian or Alaska Native (Not Hispanic or Latino) – A person having origins in any of the original peoples of North or South America (including Central America), and maintain tribal affiliation or community attachment ☐ (4) Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, Central or South American or other Spanish culture or origin, regardless of race ☐ (5) Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) – A person having origins in any of the peoples of Hawaii, Guam, or other Pacific Islands ☐ (6) Two or More Races (Not Hispanic or Latino) –All persons who identify with more than one of the above six races CFN 552-0318 Revised 12/07/16 Page 1 of 4 Employee Name Date FACTORS RELATING TO YOUR COMPLAINT (continued) 7..

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