Affirmative Action Form

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AFFIRMATIVE ACTION FORM
EQUAL EMPLOYMENT OPPORTUNITY
I am aware of the provision of Part 60-1.4(B) of Section 41 of the Code of Federal
Regulations and hereby certify that I shall:
1.
Not discriminate against any employee or applicant for employment because of
race, color, religion, sex, or national origin. The Vendor will take affirmative action to ensure
that applicants are employed, and that employees are treated during employment without
regard to their race, color, religion, sex, or national origin. Such action shall include, but not
be limited to the following: Employment, upgrading, demotion, or transfer; recruitment or
recruitment advertising; layoff or termination; rates of pay or other forms of compensation;
and selection for training, including apprenticeship. The Vendor agrees to post in conspicuous
places, available to employees and applicants for employment, notices to be provided setting
forth the provisions of this nondiscrimination clause.
2.
Will, in all solicitations or advertisements for employees placed by or on behalf
of the Vendor, state that all qualified applicants will receive considerations for employment
without regard to race, color, religion, sex, or national origin.
3.
Will send to each labor union or representative of workers with which s/he has
a collective bargaining agreement or other contract or understanding, a notice to be provided
advising the said labor union or workers' representatives of the Vendor's commitments under
this section, and shall post copies of the notice in conspicuous places available to employees
and applicants for employment.
4.
Will comply with all provisions of Executive Order 11246 of September 24,
1965, as amended, and of the rules, regulations, and relevant orders of the Secretary of Labor.
5.
Will furnish all information and reports required by Executive Order 11246 of
September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or
pursuant thereto, and will permit access to his books, records, and accounts by the
administering agency and the Secretary of Labor for purposes of investigation to ascertain
compliance with such rules, regulations, and orders.
6.
In the event of noncompliance with the nondiscrimination clauses of the Permit
or with any of the said rules, regulations, or orders, the Permit may be canceled, terminated or
suspended in whole or in part and the Vendor may be declared ineligible for further
Government contracts or federally assisted construction contracts in accordance with
procedure authorized in Executive Order 11246 of September 24, 1965, and such other
sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of
September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise
provided by law.
7.
Will include the portion of the sentence immediately preceding paragraph (1)
and the provisions of paragraphs (1) through (7) in every sub-Permit or purchase order unless
exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to section
AFFIRMATIVE ACTION FORM
EQUAL EMPLOYMENT OPPORTUNITY
I am aware of the provision of Part 60-1.4(B) of Section 41 of the Code of Federal
Regulations and hereby certify that I shall:
1.
Not discriminate against any employee or applicant for employment because of
race, color, religion, sex, or national origin. The Vendor will take affirmative action to ensure
that applicants are employed, and that employees are treated during employment without
regard to their race, color, religion, sex, or national origin. Such action shall include, but not
be limited to the following: Employment, upgrading, demotion, or transfer; recruitment or
recruitment advertising; layoff or termination; rates of pay or other forms of compensation;
and selection for training, including apprenticeship. The Vendor agrees to post in conspicuous
places, available to employees and applicants for employment, notices to be provided setting
forth the provisions of this nondiscrimination clause.
2.
Will, in all solicitations or advertisements for employees placed by or on behalf
of the Vendor, state that all qualified applicants will receive considerations for employment
without regard to race, color, religion, sex, or national origin.
3.
Will send to each labor union or representative of workers with which s/he has
a collective bargaining agreement or other contract or understanding, a notice to be provided
advising the said labor union or workers' representatives of the Vendor's commitments under
this section, and shall post copies of the notice in conspicuous places available to employees
and applicants for employment.
4.
Will comply with all provisions of Executive Order 11246 of September 24,
1965, as amended, and of the rules, regulations, and relevant orders of the Secretary of Labor.
5.
Will furnish all information and reports required by Executive Order 11246 of
September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or
pursuant thereto, and will permit access to his books, records, and accounts by the
administering agency and the Secretary of Labor for purposes of investigation to ascertain
compliance with such rules, regulations, and orders.
6.
In the event of noncompliance with the nondiscrimination clauses of the Permit
or with any of the said rules, regulations, or orders, the Permit may be canceled, terminated or
suspended in whole or in part and the Vendor may be declared ineligible for further
Government contracts or federally assisted construction contracts in accordance with
procedure authorized in Executive Order 11246 of September 24, 1965, and such other
sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of
September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise
provided by law.
7.
Will include the portion of the sentence immediately preceding paragraph (1)
and the provisions of paragraphs (1) through (7) in every sub-Permit or purchase order unless
exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to section
204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding
upon any successor or assign of the Vendor. I will take such action with respect to any sub-
Permit or purchase order as the administering agency may direct as a means of enforcing such
provision, including sanctions for noncompliance; provided, however, that in the event the
Vendor becomes involved in, or is threatened with, litigation with a successor or assignee or
the administering agency, the Vendor may request the United States to enter into such
litigation to protect the interests of the United States.
Vendor Company Name: _______________________________________________________
Signature:
Name: ______________________________________________________________________
Title: _______________________________________________________________________
Dated: ______________
For Office Use Only
File No._______________________
Date Rcv.:_____________ Via____________
Rcv By:_____________________________
Print Name__________________________
Dept:________________________

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