Equal Opportunity & Affirmative Action Survey

Equal employment and affirmative action regulations require us to gather statistical information on persons applying for employment. Please complete the survey below to assist us in complying with these regulations. In no way will your responses be used to determine your eligibility for the position for which you are applying. This information is voluntary and confidential and will be used for statistical purposes only.

Required fields are marked.

Personal Information:

Date:	(MM/DD/YYYY)
Name:
Email:
Department:
Position Number:
Position Title:
Sex:	Male Female

Ethnic Background:

Please select only one.

	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.
	Black; not of Hispanic origin. A person having origins in any black racial groups of Africa.
	Hispanic; A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish cultures or origins.
	Caucasian; not of Hispanic origin. A person having origins in any of the original peoples of Europe(except Spain and Portugal), North Africa, or the Middle East.

Asian or Pacific Islander

	Asian Indian (India, Pakistan, Bangladesh, Sri Lanka, Nepal, Sikkim, and Bhutan).
	Chinese
	Filipino
	Hawaiian or Part Hawaiian
	Japanese or Okinawan
	Korean
	All other Asian or Pacific Islanders

Other

Please specify other ethnic background if none of the above: