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EEO STAFFING PLAN
| RFP Title: |
| CONTINUOUS PATIENT MONITORING SYSTEM |
Pursuant to the above referenced RFP, the entity identified below hereby submits this EEO Staffing Plan to Roswell Park. Any defined terms in the RFP shall have the same respective meanings in this EEO Staffing Plan. All defined terms in this EEO Staffing Plan in the singular form will be construed to include the plural and vice versa.
INSTRUCTIONS: SEE PAGE 2 FOR INSTRUCTIONS
| Company’s Full Legal Name: (select: |_| Respondent |_| Subcontractor) |
| Federal Tax ID #: |
| Company’s Address: |
| City, State, Zip Code: |
Report includes (must include Subcontractors):
|_| Workforce to be utilized on the Resultant Agreement
|_| Total workforce
ENTER THE TOTAL NUMBER OF EMPLOYEES FOR EACH CLASSIFICATION IN EACH OF THE EEO-JOB CATEGORIES IDENTIFIED
| EEO-Job Category |
| Total Workforce |
| Workforce by Gender |
| Workforce by Race/Ethnic Identification |
| Workforce by Other Status |
| White |
| Black |
| Hispanic |
| Asian |
| American Indian or Alaskan Native |
| Veteran |
| Total Male (M) |
| Total Female (F) |
| (M) |
| (F) |
| (M) |
| (F) |
| (M) |
| (F) |
| (M) |
| (F) |
| (M) |
| (F) |
| (M) |
| (F) |
| (M) |
| (F) |
| Executive/Senior Level Officials & Managers |
| First/Mid-Level Officials & Managers |
| Administrative Support Workers |
FAILURE TO SUBMIT COMPLETE AND ACCURATE INFORMATION MAY RESULT IN A FINDING OF NON-COMPLIANCE AND/OR TERMINATION OF THE RESULTANT AGREEMENT.
| Prepared By (signature): |
| Date: / / |
| Name of Preparer (printed): |
| Phone: ( ) - , Ext. |
| Fax: ( ) - |
| Title of Preparer (printed): |
| Email: |
INSTRUCTIONS
Whenever required in the RFP, the Respondents and each of their Subcontractors shall complete this EEO Staffing Plan and include it as part of each Respondent’s Proposal.
Where the workforce to be utilized in the performance of the Resultant Agreement, if awarded by Roswell Park, can be separated out from a Respondent’s and/or a Subcontractor’s total workforce, then each such Respondent and/or Subcontractor shall complete this EEO Staffing Plan only for the anticipated workforce to be utilized on the Resultant Agreement, if awarded by Roswell Park. Where the workforce to be utilized in the performance of the Resultant Agreement, if awarded by Roswell Park, cannot be separated out from a Respondent’s and/or a Subcontractor’s total workforce, then each such Respondent and/or Subcontractor shall complete this EEO Staffing Plan for the Respondent’s and/or Subcontractor’s total workforce.
For the purposes of this EEO Staffing Plan, an employee may be included in the group to which he or she appears to belong, identifies with, or is regarded in the community as belonging. However, no person should be counted in more than one (1) race/ethnic group. The identification categories and definitions for this EEO Staffing Plan are as follows:
| Identification |
| Definition |
| White |
| A person having origins in any of the original peoples of Europe, North Africa, and/or the Middle East. (Not of Hispanic origin.) |
| Black |
| A person having origins in any of the black racial groups of the original peoples of Africa. (Not of Hispanic origin.) |
| Hispanic |
| A person of Mexican, Puerto Rican, Cuban, Central and/or South American, and/or other Spanish culture and/or origin, regardless of race. |
| Asian |
| A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, and/or the Pacific Islands. |
| American Indian or Alaskan Native |
| A person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation and/or community recognition. |
| Veteran |
| A member of the armed forces of the United States who: (i) served therein in time of war; (ii) was honorably discharged or released under honorable circumstances from such service; and (iii) who is a citizen of the United States or an alien lawfully admitted for permanent residence in the United States. |
| Rev. Oct. 2018 |
| Page 1 of 2 |
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