Read the following carefully before completing Part II of this form.
To All Prospective Members of Advisory Committees:
The establishment and operation of all advisory committees in the Executive branch is governed by the Federal Advisory Committee Act, Public Law 92-463. Among its many requirements, the statute requires that the membership of an advisory committee be balanced that is, fairly and equitably represent, to the extent feasible, all the various interests that may be affected by the committee's work and that undue weight not be afforded the views of any one interest.
Depending upon the specific area of a committee's concern, balance may mean adequate representation of consumers and industry, west coast and east coast shippers, labor and management, etc. The Office of Management and Budget, which was given the overall administration and guidance of advisory committees, in it's letter January 28, 1975 to Heads of Executive Departments and Agencies urged promotion of other aspects of balance such as sex and race.
Another consideration which persists throughout all committees is political affiliation. Advisory committees would lose their integrity and effectiveness if they were permitted to become vehicles for the propagation of partisan political views. Moreover, our integrity as an agency of the Government would be impaired if the public believed that we stock our advisory committees with members of the President's political party who simply rubber-stamp all actions.
As a consequence, one item of information which we seek on the biographical form is your political affiliation. Because of the Privacy Act of 1974, however, we need your permission to keep this item of information. The Privacy Act prohibits an agency of the Government from keeping information on how a person exercises the rights guaranteed by the First Amendment to the Constitution unless, as in this instance, that person expressly authorizes the agency to do so. It is generally considered that the right to join and support a political party derives from the First Amendment rights of Free Speech and Assembly. Hence, the biographical form also contains a statement which we ask that you sign authorizing the Department of Transportation to maintain information about your political affiliation.
We have requested your social security number, date and place of birth for identification purposes. It is not mandatory that you furnish your social security number, although we would appreciate having it. However, we do need to have your date and place of birth.
Committee Management Officer
Enter information requested on the front and reverse sides of this part of the form, separate from Part I along the perforation above, and return to the department of Transportation as instructed in the accompanying letter.
| NAME (First, Middle, and Last)
||HOME ADDRESS (No., Street, City, State, and ZIP Code|
|SOCIAL SECURITY NO.||DOB (Month, Day, and Year)|| SEX
| PLACE OF BIRTH (CITY AND STATE (OR FOREIGN COUNTRY))
|RACE/ETHNIC BACKGROUND (See reverse)
__ A __ B__ C __ D __ E
|POLITICAL AFFILIATION (See reverse)
__ Democrat __ Republican __ OTHER (specify) ---------------------------
| PROFESSIONAL OR BUSINESS EXPERIENCE
| PRESENT OCCUPATION OR TITLE
| EMPLOYING ORGANIZATION AND ADDRESS
| PARENT ORGANIZATION (if employing organization is a subsidiary)
| AFFILIATION (If above information does not reflect candidates expertise vis--vis the committee)
| MEMBERSHIP ON OTHER ADVISORY COMMITTEES, PAST OR PRESENT
| NAME OF COMMITTEE YOU ARE INTERESTED IN
| CIVIC ACTIVITY (If pertinent)
| CANDIDATES SIGNATURE
Information requested on this form is made under provisions of P.L. 93-579 of the Privacy Act of 1974. It is to be used as background information for prospective members of advisory committees. At your request, this Department will disclose to you the identity of any person or organization to whom we release such information. Information concerning sex, race, and political affiliation is requested for the purpose of obtaining balance in those areas on advisory committees. Failure to provide such information may delay consideration of your appointment,
Pursuant to the Privacy Act's provision on the maintenance by Government agencies of information describing how an individual exercises rights guaranteed by the First Amendment, I authorize the Department of transportation to maintain information on my political affiliation. The above statement to be signed by candidate, after reading Part I of this form.
A = American Indian or Alaskan Native. A person having origins in any of the original peoples of North America, and who maintains cultural identification through community recognition or tribal affiliation.
B = Asian or Pacific Islander. A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands, and Samoa.
C = Black, not of Hispanic origin. A person having origins in any of the black racial groups of Africa. Does not include persons of Mexican, Puerto Rican, Central or South American, or other Spanish cultures or origins (see Hispanic).
D = Hispanic. A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish cultures or origins. Does not include persons of Portuguese culture or origin.
E = White, not of Hispanic origin. A person having origins in any of the original peoples of Europe, North Africa, or the Middle East. Does not include persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish cultures or origins (see Hispanic). Also includes persons not included on other categories.