sf 181 form faxed the department of management and budget for :sa-auset :tauwieret
DESCRIPTION
SF 181 form faxed the Department of Management and budget for :Sa-Auset :TauweirtertTRANSCRIPT
Title 4 U.S.C. 1-4; Article 55 and 56 United Nations Charter;
Congressional Record Page A32220 of May 11, 1955
lnter-American Declaration On
the Rights of lndigenous Peoples
Title 50 U.S.C., Appendix Sections 7(cl,7lel, 9,L2.
1917 Trading with the Enemy Act
To: The Office of Management and Budget
725t7tn Street, NW
Washington, DC 20503
FAX: 202-395-3888
From: Nicole Tamara Nicholas
Re: SF FORM 181
Pages in this fax including cover sheet: 13
Title 42 U.S.C. 1985.
45 Stat. 40L;54 Stat.670
Title 28 U.S.C. 1333.
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U. S. Office of Personnel ManagementGuide to Personnel Data Standards
Narne (Last, First, Middle lnitial)
; ULCyE TSocial Security Number
010,-b,L-b CIO >
MCIAL CATEGORY(Check as many as apply)
@EAmerican lndian or Alaska Native
fl Asian
ff Black orAfrican American
D Native Hawaiian or Other Pacific lslander
BWhite
ETHNICITY AND RACE IDENTIFICATION(Please read the Privacy Act Statement and instructions before completing form.)
Birthdate (Month and Year)
7-t-7rAgency Use Only
Pfivac! Act Statement
Ethnicity and race information is requested under the authority of 42 U.S.C. Section 2000e-16 and in compliance withthe Office of Management and Budget's 1997 Revisions to the Standards for the Classification of Federal Data on Raceand Ethnicity. Providing this information is voluntary and has no impact on your employment status, but in the instanceof 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. ttis also used by the U. S. Office of Personnel Management or employing agency maintaining the records to locateindividuals for personnel research or survey response and in the production of summary descriptive statistics andanalytical studies in support of the function for which the records are collected and maintained, or for related workforcestudies.
Social Security Number (SSN) is requested under the authority of Executive Order 9397, which requires SSN be usedfor the purpose of uniform, orderly administration of personnel records. Providing this information is voluntary and failureto do so will have no effect on your employment status. If SSN is not provided, however, other agency sources may beused to obtain it.
Specific lnstructions: The two questions below are designed to identify your ethnicity and race. Regardless of your answer toquestion 1, go to question 2.
Question l. Are You Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or otherSpanish culture. or origin, regardless of race.)
Yes fl tto
Question 2. Please select the racial category or categories with which you most closely identify by placing an "X" in the appropriatebox. Check as many as apply.
DEFINITION OF CATEGORY
A person having origins in any of the original peoples of No(h and South America(including Central America), and who maintains tribal affiliation or communityattachment.
A person having origins in any of the original peoples of the Far East, SoutheastAsia, or the lndian subcontinent including, for example, Cambodia, China, lndia,Japan, Korea, Malaysia, Pakistan, the Philippine lslands, Thailand, and Vietnam.
A person having origins in any of the black racial groups of Africa.
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, orother Pacific lslands.
A person having origins in any of the original peoples of Europe, the Middle East, orNorth Africa.
Standard Form 181
Revised August 2005Previous editions not usabk
42 U.S.C. Section 2000e-1(
NSN 7540-01-099-3446
In the Houee of Repreeentatiues, U, 5,,,luly ltt, :ltltttl.
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lrit's ti'om l(il!) tlrouglr ISliS;
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tlrt' loss uf lnrrrurrr rligrrity. tlrl firtstt'ltiorr uf mrrt,i-.rs ilrrrl
prrrfr'ssiuutl livt,s. tttul tlx, lorrg-terltr krss of itrr,rnnt. ;trxl( llllx rrtuilitil';
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uf .\t'rinul-lrru'r'icirris irrrtl tltc rlt,lrutniurizing irtr'{xtiii(.H
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rrrirrirrriztrd ilr tlu. trllirrg ,rf .\nx..rictttr lristor'.r';
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is sct: lilx.r't'r, itttrl,irtstit.tr tirt' itll.";
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rt lrrtr lu' irrit iirtrtl rt tuttiottttl tlittltgttt' rtlxrttt tttt't';
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n,solrttiotts: itrrtl
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l;.i;l{}r
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(lrrvr.,lrr)r,r)t yliqr rf ft>tt,u) nnxs>lil, )nr)uilu,1, iltr )nlb-
irrotts 'l'riril of 'li.at's irrul l,otig \\'llk;lJ) rlrrritrg lrkxxll' rn'urld t'rttrti'ulttittions illl(l ntrts-
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tiorrs. lrclit'f'.x. irrxl rrtstonrs ot'tltt. Native l'toltlcs ilttd ctt-
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tribrrliotr o[' lrrul rrrrtlcr tltc (ft'tterttl r\lltttttx'ttt .r\r't of
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tlu'ir tirrnilit,s to farrrrva.r' lxrat'rling st:lttxrls u'lrtrtrt tltcit'
Nirtile purr.tir.es alrtl lnugttirsrr \rut'(! tlcgttttletl ttttcl ttrt.
tridtlcrr:
\\:lrcrr,ns ol'{iriuls ol' tlte ['rrilt.tl Stltt,x (iovrt'tttttt'ttt rtttrl lrri-111f1 [i11it1ril Sttrtcs citizr,rrs lrrrrrtit'tl Ntttivrr ltt'rtplt's h.v tltc
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rtsottr(r,)i firrtlr srtt.lr tr.t't'itut'ir's. attrl tlrt'ttlisttttttltllS'tttt'ltt
ol' lriirll trttsi iittrtis;
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lr.v tlt'". I'rrirtrl St;rfls, tllu Nirtilr, ['ru1tk's lrrrt'c rrrrrr*irrr,rI
rt,rrtiltittt,rl to tlrr, ;rrutg..tiorr uf tllis ilr*tt liurtl, trs t,r'i-rh'rtrt'tl h.r'tlrr,f'rrt,t tlruf. ()n I l1(,r t,apittr Irrtxis. rrrrrrr. \ir-1i1'1r pr,o[)lt, lurrr. sr.rrrrl irr llrt' ['rritetl titlrtr's .\t.rrrr.rl
Ir'rltr'(..)i ancl prlac*tl tlrrrriist,llr..s itr lrrr.t.trt's rvrtf iu drrti:trxt,
of rlre {'rritt,tl Strtl,,r irr ,,rer'.v rriili*r't}lilit*t}'r,orr11it.t tlrirrr
rutv rdlrt't' t'llrrric gll,ll[];
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volyr.,nrcut of r'tittit'r.r inrlititluals irr oftirial Irrritul Statt,s(ir;vcrlrnrurt prositiurrs. anrl lx icadcrship of tlrt:il' orrrr
sorrrrr.igrr lnrlitrr t rilx,s:
\\'ltr,n,*ts Itrtliurr tlilx.s rtt rt:*iliurrt iurtl rlttu'niirull to Jirr,-*111,1', {lr,\'{rlop, rlrtrl lnrrtsrttit fo ftrtrll'ti gcrtr.t'ttfions tlrlirturit gut r:rtlturirl irLrrrtifit,ri;
\\'lrt.r'trt* tlre NatiorrHl ][uxrrunr of tlrt ,\rrrr-.rirarr [rrtliirrr rvas
cstttltlixhctl u'itltin tltc $nritlrsurriarr lrrstitution as a llr"irrgntut){}ri*l (o tlr* }iatirrr l)r,oplt.x urnl tlruir trlxliti(}r}s; rnr(l
\\'lt*rtrrs Ntttivrr I'r:rpk,s ru1, (,rr(lr)u'[rtl h,v their (:rl'attir rritlr(ftirtilitl rrrralir.,rraltl* r'iglrts. irnr.l thrrt. rlnt()llg tlruurr art. lifi'.
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5 tlrt'soh,lrtr rovlrrrurt u'ith tlu' larrrl u't, slrrrrt.:
6 li) r'utrttttr,tttls irtrrl lrotrrit's llrl Nirtirt l'r'o1rh,x l'rrt' llrt'
7 tltottxitrtrls oi'r',,at's tlrat tltr..r'lrrrvl str.rrltrltrl arul llrrrtr'r.tr.rl
I this lrrrrrl:
I lill lr.krrorvltrlpn .rt*r's of' oftlt.ill th,ilrrrlrrtiorrs. ill-
[0 (.r)nrf ivr.tl 1xrlir.it.s. rttttl tlrt, lrt't,rtkitrg nf ({}\l,nrults lr.v tlur
I I Urrittrl Stirtt,s (hx'('r'unlr.'ut tr.gartlirrg Itrtli;trt trilxrsl
12 (-[) lgxrlugizes titr lx'lurll'of tlu, puu;tlr of llre' Iirritr.tl
l3 l'ititt|s to rrll Iratir'1' l>111;111.s ttir tlrt' [liut.v irrstilrrrt,s ilf Yiil-
I4 lt.Il{rrt, ulrrltl'rruttttrrtt, it}l{l n{'glcrt irrflirttrl ott l{tttivr, [)r.rr-
l5 lrlus h1' ritizt,rrx uf ttrt.. [.'rritr:tl Statt's:
I6 i.'r) (.stlr1.$s('s iis rr,Sl'('1. firr llrr litrrrifiratirurs rrl'
17 titnrrcr uf't't'nu,s rrrul its ronrrrrilrrx'rrt to Iruiltl otr tlrt. gxrxi-
l8 tir-e rrlittiorrsltips of tlrt' past alxl presorrt to nrof it torvittrl
l9 a lrriglrtr,r' hrtrn'r, n'h<.r'c lll thr. p.opkr rlf tlris larrrl lirl rt,r.-
20 olu'ik,rl rts lrrr:ltlrlrs an(l sist(,r's. lul(l lrrrnlloltiottxll' stt,rrittrl
2l irn(l l)r'otc(:t tlris larrtl trigr..tltlr';
22 tii) rrrges tlrt, l)rrsitk'nl t{, il(.knorvltrlgt tlrc oi'ti,trst's
2l rrf tlr(. IIrrit,'rl Statex irgrliust Irrrlirrrr trillex irr tlte ltistru'r'
?4 ol'tlrr, Ilrrillrl Slirtr,s irr orrllr to lrrirrg lrt'ulirrg l.o this Iurrrl
75 lrr' ;rruvitlittg it l)trrln,t' tirttttrlrttiotr tirt' tlt'otrriliatiorr lx,-
?6 tnrr,rr llrr, ilrritrrl Stitlr.s irtrrl ltrtliirtr tt'ilx'sr ittrrl
oHJ I lH
I
7
3
4
5
6
7
{i
(71 (,{)nlnl(,n(l$ tlur l{trrte g{rvt nlnlt nt* tllut lttrt'e
bcgurr rrtorreililtir"rrr r:tttrrtx rvitlr nr:ogrriz.cxl Irulitn trilxrs
Itr.attrtl irr tlttir txunulflrit,x llrul (,u(.oln'rrgr.s tll Sttte gyrv-
cnuncuts xirnil*r'[v to rrurk tolr':url luconcilirrg rulittiou-
shipx rviflr Inrlinrr trilx,s rvitlrirr tlrt'ir lxlrrrtlaries.
gEC. g. DISCI.AIMEB"
),lollrirrg irr tlrix'loirrt. lll.solutiotr rurtltoriet,s ittrl' rluinr
ttgiiittst ilr.' L]rritr.l Stitt.';' rrr' Nt,l \-(.rt irr. ir st.ttlrtrrr.rrt ,rl'arr.I'
tlninr ag$irrst tho I'nitcd St*tr's.
(-)
II
rllrl I lH
ffiafq$r#rr{.ryJ trrFl
ri?drfrLF5ffStrTi-Sffi
'ff 'FS;}jS-iff }ell*lrlrg'gjf f f f p;i*affitrjprris,rr@?iffi 'ysffiJ{J}";}str1;gt
rrlHl.rff
tEprrt u1[.r ,ituzu I aqt u! FHr]rT sB.$ u * Holinu]su{}J *r,{I 14 pErH]t
3,s$ 5n.'$ ,{}u*tpny sq,1 .t.].{"I3 },}rlg ,{irr*rr"r&}l{ 11rrr-rp {?f##r.{*x5.
&?ff{I$Jrr "}''.}tr-filJr i};}s'i=JstrEt{:} it{l ul ll prll} [8131 5r.{ {r{}nntrxt1TH}'$ s-q''
u$ tsv $rlt"&{T .,il5l*qlny' Faiti uru satrp sr{Jt 'mfmB$I[ff.n@';i.i
ffi8q55ry -r,.ru pue "s{in rtrnE
el$-lal rWHlr+ u.*rl aABr{ r$Hur u{ilt$[t;r*][Ju",itgp11r,r r:qt uo Eurpl,r*p
**pn: .iuy :ir,tu*pu*.1rr splitt S lt{t.gr: ."iur rp1,n slE}F rltIE,H .Sfhl
**u{s ss*xfur;r;-} dq unrt*1srfr*; 1u ril ,{Jddu iir,tr .urluuogfttpsrrr:r;7
.ir) If;.?t .srN" " ql '{t]ffiT-fl/ilif}{rsf#fir $u6,r/$,\ partq? *}Er.t;?r
5'-,, r51 irl) tH&Suflt $HIR;'tltti'!t i{{l qlltr ilHtrrru.f S.LIJB}I ltl*pi$}Jr[
tq prufrm !"iil$,r_f) rrTi siilirgg5r?;riff Tiary .1{fl r.*q } 'itr;rr.r
1 :;, *"rr.rddx ir* Flu irr+u r+ {rJ#i-lBN IH'l1.ql r*Ii' lH-i5iigtlliS*l6q;pu* Sg n"lfl$$t'V ur grunrli ;rJn asii{l '1-#,riit,rr1J prFffi3r{rfrEr*ffiS
lit*Jirfi#J?jhj": .'glnssFrra.lr! liFlsu ;r:l-a*{} ul sTQSElS-ui{Erili al*ulrr*rj
tlr 3*r1{:U i:sr$ffitlE11 *t{l 'Jsprirt t*6 ts$l "{1ur: sU 'qJ.},qr*ul Fu,rteg}taF}
t$ ut.ls.ris lgrrnuflllt$Lin* xlr iq prln$rt .laEurrl tlc 5r sr*"rBuril;1
fiur):t:tu eHt utlcsuftilBg p5fruri Hffilr r*rr*{i3
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