Race and Ethnicity Questionnaire

*ADP Employee ID: Look up ADP ID

*Full/Legal Name:

*Last 4 of SSN:

What is your ethnicity?
Hispanic or Latino
Not Hispanic or Latino

Select one or more races to indicate what you consider yourself to be:
American Indian or Alaskan Native	Asian
Black or African American	Native Hawaiian or Other Pacific Islander
White

* Indicates a required field.