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 Initial) Social Security Number Birthdate (Month and Year)

SIMILIEN, PERI 04/30/1971

Agency Use Only

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 Office of Management and Budget's 1997 Revisions to the Standards for the Classification of Federal
Data on Race and Ethnicity. Providing this information 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. It 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 purpose 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. If SSN is not provided, however,
other agency sources may be used to obtain it.
Specific Instructions: The 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
Spanish culture or origin, regardless of race.)
Yes No
Question 2. Please select the racial category or categories with which you most closely identify by placing an "X" in the appropriate
box. Check as many as apply.
RACIAL CATEGORY
DEFINITION OF CATEGORY
(Check as many as apply)

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

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.

Black or African American A person having origins in any of the black racial groups of Africa.

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

White 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

NSN 7540-01-099-3446
X – Moor - 667
X – Moroccan – 633
X – Asiatic - 463
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Definitions for New Race and Ethnicity

Categories

Race/ethnicity (new definition)

Categories developed in 1997 by the Office of Management and Budget (OMB) that are used to describe groups to which
individuals belong, identify with, or belong in the eyes of the community. The categories do not denote scientific definitions
of anthropological origins. The designations are used to categorize U.S. citizens, resident aliens, and other eligible non-
citizens. Individuals are asked to first designate ethnicity as:

Hispanic or Latino or
Not Hispanic or Latino

Second, individuals are asked to indicate one or more races that apply among the following:

American Indian or Alaska Native

Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

Hispanic or Latino

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

American Indian or Alaska Native

A person having origins in any of the original peoples of North and South America (including Central America) who
maintains cultural identification through tribal affiliation or community attachment.

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.

Black or African American

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

Native Hawaiian or Other Pacific Islander

A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White

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

Nonresident alien

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A person who is not a citizen or national of the United States and who is in this country on a visa or temporary basis and
does not have the right to remain indefinitely. Note: Nonresident aliens are to be reported separately in the places
provided, rather than in any of the racial/ethnic categories described above.

Resident alien (and other eligible non-citizens)

A person who is not a citizen or national of the United States but who has been admitted as a legal immigrant for the
purpose of obtaining permanent resident alien status (and who holds either an alien registration card (Form I-551 or I-
151), a Temporary Resident Card (Form I-688), or an Arrival-Departure Record (Form I-94) with a notation that conveys
legal immigrant status such as Section 207 Refugee, Section 208 Asylee, Conditional Entrant Parolee or Cuban-
Haitian). Note: Resident aliens are to be reported in the appropriate racial/ethnic categories along with United States
citizens.

Race/ethnicity unknown

The category used to report students or employees whose race and ethnicity are not known.

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 H. Res. 194

Whereas millions of Africans and their descendants were

enslaved in the United States and the 13 American colonies
from 1619 through 1865;

Whereas slavery in America resembled no other form of

involuntary servitude known in history, as Africans were
captured and sold at auction like inanimate objects or
animals;

Whereas Africans forced into slavery were brutalized,

humiliated, dehumanized, and subjected to the indignity of
being stripped of their names and heritage;

Whereas enslaved families were torn apart after having been

sold separately from one another;

Whereas the system of slavery and the visceral racism

against persons of African descent upon which it depended
became entrenched in the Nation's social fabric;

Whereas slavery was not officially abolished until the

passage of the 13th Amendment to the United States
Constitution in 1865 after the end of the Civil War;

Whereas after emancipation from 246 years of slavery,

African-Americans soon saw the fleeting political, social,
and economic gains they made during Reconstruction
eviscerated by virulent racism, lynchings,
disenfranchisement, Black Codes, and racial segregation laws
that imposed a rigid system of officially sanctioned racial
segregation in virtually all areas of life;

Whereas the system of de jure racial segregation known as

``Jim Crow,'' which arose in certain parts of the Nation
following the Civil War to create separate and unequal
societies for whites and African-Americans, was a direct
result of the racism against persons of African descent
engendered by slavery;

Whereas a century after the official end of slavery in

America, Federal action was required during the 1960s to
eliminate the dejure and defacto system of Jim Crow
throughout parts of the Nation, though its vestiges still
linger to this day;

Whereas African-Americans continue to suffer from the

complex interplay between slavery and Jim Crow--long after
both systems were formally abolished--through enormous damage
and loss, both tangible and intangible, including the loss of
human dignity, the frustration of careers and professional
lives, and the long-term loss of income and opportunity;

Whereas the story of the enslavement and de jure

segregation of African-Americans and the dehumanizing
atrocities committed against them should not be purged from
or minimized in the telling of American history;

Whereas on July 8, 2003, during a trip to Goree Island,

Senegal, a former slave port, President George W. Bush
acknowledged slavery's continuing legacy in American life and
the need to confront that legacy when he stated that slavery
``was . . . one of the greatest crimes of history . . . The
racial bigotry fed by slavery did not end with slavery or
with segregation. And many of the issues that still trouble
America have roots in the bitter experience of other times.
But however long the journey, our destiny is set: liberty and
justice for all.'';

Whereas President Bill Clinton also acknowledged the deep-

seated problems caused by the continuing legacy of racism
against African-Americans that began with slavery when he
initiated a national dialogue about race;

Whereas a genuine apology is an important and necessary

first step in the process of racial reconciliation;

Whereas an apology for centuries of brutal dehumanization

and injustices cannot erase the past, but confession of the
wrongs committed can speed racial healing and reconciliation
and help Americans confront the ghosts of their past;

Whereas the legislature of the Commonwealth of Virginia has

recently taken the lead in adopting a resolution officially
expressing appropriate remorse for slavery and other State
legislatures have adopted or are considering similar
resolutions; and

Whereas it is important for this country, which legally

recognized slavery through its Constitution and its laws, to
make a formal apology for slavery and for its successor, Jim
Crow, so that it can move forward and seek reconciliation,
justice, and harmony for all of its citizens: Now, therefore,
be it
Resolved, That the House of Representatives--
(1) acknowledges that slavery is incompatible with the
basic founding principles recognized in the Declaration of
Independence that all men are created equal;
(2) acknowledges the fundamental injustice, cruelty,
brutality, and inhumanity of slavery and Jim Crow;
(3) apologizes to African Americans on behalf of the people
of the United States, for the wrongs committed against them
and their ancestors who suffered under slavery and Jim Crow;
and
(4) expresses its commitment to rectify the lingering
consequences of the misdeeds committed against African
Americans under slavery and Jim Crow and to stop the
occurrence of human rights violations in the future.