GROSSMONT-CUYAMACA

COMMUNITY COLLEGE DISTRICT AUXILIARY ORGANIZATION

11 –RECRUITMENT INFORMATION (VOLUNTARY)

As a means of complying with regulations issued by the Office of Federal Contract Compliance Programs (41 CFR Part 60), institutions of higher education are required that applicants voluntarily submit information to the ethnic, race gender, or disability background. This confidential information is used to evaluate compliance with federal non-discrimination requirements.

Upon filing an application, this self-disclosure form is removed from your application packet and forwarded to the Employment Services Offices for use in accordance with equal employment opportunity and federal affirmative action guidelines. Failure to complete this form will not affect your application.

Name:
Last / First / M.I. / Position applying for:

1. Sex: Male Female

2. Age: Under 40 Over 40

3. Are you a person with a disability? Yes No

“Person with a disability” means any person who (1) has a physical impairment that substantially limits one or more of such person’s major life activities, (2) has a record of such impairment, or (3) is regarded as having such impairment. A person with a disability is “substantially limited” if he or she is likely to experience difficulty in securing, retaining, or advancing in employment because of a disability.) (Title 5, Sec. 53001)

4. Are you a Disabled Veteran? Yes No

5. Are you a Vietnam Era Veteran? (Time period 8/64 – 5-75) Yes No

  1. Printed below are the federal definitions established by the Office of Federal Contract Compliance Programs. Please select one of the following groups with which you most identify.

White (Not Hispanic) / All persons having origins in any of the original people of Europe, North Africa, or the Middle East.
Black / All persons having origins in any of the Black African racial groups not of Hispanic origin.
Hispanic / All persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish Culture or origin, regardless of race.
Asian / Pacific Islander / All persons having origins in any of the original people of the Far East, Southeast Asia, the Indian Subcontinent, the Pacific Islands, the Philippine Islands, or the Hawaiian, Samoan, or other islands of the South Pacific Area.
American Indian / Alaskan Native / All persons having origins in any of the original peoples of North America and maintaining identifiable tribal affiliations through membership and participation or community identification.

7. Where did you first learn of this position? Please check the appropriate box.

GCCCD Auxiliary Website / GCCCD Auxiliary Employee
Craig’s List Website / Other (please specify)______
Public Agency or Library

8. I decline to complete this form.

Applicant’s Signature / Date