000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000111111111111111111111111111111111
000000000111111111122222222223333333333444444444455555555556666666666777777777788888888889999999999000000000011111111112222222222333
123456789012345678901234567890123456789012345678901234567890123456789012345678901234567890123456789012345678901234567890123456789012

   CO=XXXXXX-X						EQUAL EMPLOYMENT OPPORTUNITY					    PAGE XXX
    U=XXXXXX-X					  20XX EMPLOYER INFORMATION REPORT EEO-1
NAICS=XXXXXX
						   SINGLE-ESTABLISHMENT EMPLOYER REPORT


SECTION B-COMPANY IDENTIFICATION								SECTION C-TEST FOR FILING REQUIREMENT

1.  COMPANY NAME (35)----------------->		2.a.  COMPANY NAME----------------------->	1-X  2-X 3-X DUNS NO.: XX-XXX-XXXX
    COMPANY ADDRESS------------------->		      COMPANY ADDRESS-------------------->	
    CITY----------->  COUNTY---------->	              CITY----------->  COUNTY----------->	SECTION E-ESTABLISHMENT INFORMATION
    ST	ZIP->					      ST->  ZIP->
												1-<--------------------------------->
						  b.  X (WAS AN EEO-1 REPORT FILED FOR THIS	  <--------------------------------->
							 ESTABLISHMENT LAST YEAR?)		  <--------------------------------->

						  c.  EI=XXXXXXXXX		

SECTION D-EMPLOYMENT DATA
                             MALE  FEMALE ***************** MALE ****************** ***************** FEMALE ****************  TOTAL
                             HISP   HISP   WHITE  BLACK  NHOPI  ASIAN NAT AM 2+RACE  WHITE  BLACK  NHOPI  ASIAN NAT AM 2+RACE   A-N
 JOB CATEGORIES               (A)    (B)    (C)    (D)    (E)    (F)    (G)    (H)    (I)    (J)    (K)    (L)    (M)    (N)    (O)
                           
 EXEC/SENIOR MGRS... (1.1)  XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX
 FIRST/MID-LVL MGRS. (1.2)  XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX
 PROFESSIONALS ..... (2  )  XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX
 TECHNICIANS ....... (3  )  XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX
 SALES WORKERS ..... (4  )  XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX
 ADMIN SUPPORT ..... (5  )  XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX
 CRAFT WORKERS ..... (6  )  XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX
 OPERATIVES  ....... (7  )  XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX
 LABORERS & HELPERS. (8  )  XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX
 SERVICE WORKERS ... (9  )  XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX
                                                                                                                                        
               TOTAL (10 )  XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX
                                                                                                                                        
 PREVIOUS YEAR TOTAL (11 )  XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX XXXXXX


 DATES OF PAYROLL PERIOD: XX/XX/20XX THRU XX/XX/20XX


 CERTIFICATION:

 CERTIFYING OFFICIAL:<---------------------------------->       TITLE:<------------------------------->  TELEPHONE NO: XXX-XXX-XXXX

			EMAIL:<------------------------->

 EEO-1 REPORT CONTACT PERSON:<-------------------------->       TITLE:<------------------------------->  TELEPHONE NO: XXX-XXX-XXXX

			EMAIL:<------------------------->	STREET ADDRESS:<------------------------------------------------>

								CITY/ST:<------------>	ST	ZIP:XXXXX