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Office of Social Equity and Civic Engagement

Confidential Employment Applicant Data Collection Form: Staff

Indiana University of Pennsylvania is committed to providing leadership in the attainment of equal employment opportunities for all persons. Accordingly, every effort will continue to be exerted to avoid unlawful discrimination against protected groups and to develop affirmative action programs to employ them at all organizational levels, in compliance with all applicable federal and state laws, and executive orders.

To ensure the effectiveness of the university’s affirmative action program, applicants are requested to answer the questions listed below. This information, provided by the applicant in personally non-identifiable form, will be used only for statistical compilation and report filing. This information will not be a part of the institution’s employment decision with regard to the applicant. Since ethnicity/race/sex identification is a critical reporting factor, data collection forms with no ethnicity/race/sex identification will not be processed.

All fields are required unless otherwise specified. Please check the appropriate categories.

(Optional)


Gender
Veteran Status

  1.      Any honorably discharged person who served in the armed forces of the United States, or any women’s organization connected with those forces, during any war or armed conflict, or who has served since July 27, 1953. This service in the armed forces includes training time and service in the state National Guard and the United States Army Reserve.

  2.      A veteran entitled to compensation (or one who was released or discharged from active duty) for a service-connected disability.
Ethnicity

  1.      Persons of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race.
Race

  1.      Persons having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

  2.      Persons having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

  3.      Persons having origins in any of the black racial groups of Africa.

  4.      Persons having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

  5.      Persons having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Position Reference

(Optional)

(Optional)


Laws and Regulations (including subsequent amendments):  Civil Rights Act of 1964; Equal Pay Act; Age Discrimination Act; Rehabilitation Act; Education Amendments; Vietnam Veterans Readjustment Act; Executive Order 11246; The Pennsylvania Human Relations Act; The 1975 Pennsylvania Governor’s Executive Order.

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  • President's Office
  • 201 Sutton Hall
    1011 South Drive
    Indiana, PA 15705
  • Phone: 724-357-2200
  • Fax: 724-357-3060
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  • Office Hours
  • Monday through Friday
  • 8:00 a.m. – 4:30 p.m.