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Run: EEO-1 Component 1 Data Collection Form

Use this EEO-1 Component 1 Data Collection Form to gather workforce headcount by job category, race or ethnicity, and sex before annual EEOC reporting. It gi...

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Reporting Context

Reporting Year (required)

Enter the calendar year for the EEO-1 Component 1 report.

Reporting Period End Date (required)

Use the official snapshot date for the reporting period.

Submitter Name (required)

Name of the person preparing or certifying the submission.

Submitter Email (required)

Work email for follow-up questions and approval routing.

Employer and Establishment Information

Employer Legal Name (required)

Legal entity name used for the EEO-1 filing.

Employer EIN Last 4 Digits (required)

Enter only the last 4 digits of the EIN for identification and audit trail purposes.

Reporting Scope (required)

Primary Worksite State

Required only if the report is tied to a single establishment.

EEO-1 Job Category Headcount

1. Executive/Senior Officials and Managers (required)

2. First/Mid Officials and Managers (required)

3. Professionals (required)

4. Technicians (required)

5. Sales Workers (required)

6. Administrative Support Workers (required)

7. Craft Workers (required)

8. Operatives (required)

9. Laborers and Helpers (required)

10. Service Workers (required)

Race, Ethnicity, and Sex Headcount

Race or Ethnicity Reporting Method (required)

Sex Reporting Method (required)

Headcount by Job Category, Race/Ethnicity, and Sex (required)

Enter one row per applicable job category. Use numeric counts only. Do not include employee names or other direct identifiers.

Data Quality and Certification

Data Quality Review Completed (required)

Confirm that totals were reviewed for completeness, accuracy, and consistency before submission.

Yes No N/A

Known Data Limitations

Describe any data gaps, reconciliation issues, or assumptions used. Leave blank if none.

Certification Statement (required)

I certify that the information provided is complete and accurate to the best of my knowledge and was prepared using the minimum necessary workforce data for compliance reporting.

Yes No N/A

Certifier Signature (required)

Signature of the authorized submitter or certifier.

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