ORANGE COUNTY COMMUNITY COLLEGE
VOLUNTARY DISCLOSURE FORM
PLEASE PRINT
First Middle Last Date
POSITION APPLIED FOR:
WHAT IS YOUR ETHNICITY/RACE?
Ethnicity
Are you Hispanic/Latino? (A person of Cuban, Mexican, Puerto Rican, Cuban, South or Central American, or
other Spanish culture or origin, regardless of race)
No, not Hispanic or Latino Yes, Hispanic or Latino
If Hispanic/Latino, is your background (select one):
Central American Dominican Mexican Other Hispanic/Latino Puerto Rican South American
Race
Is your Race (check all that apply)
American Indian or Alaska Native (Persons having origins in any of the original peoples of North,
Central or South America, and who maintains tribal affiliation or community attachment)
Asian (Person having origins in any of the original peoples of the Far East, Southeast Asia, or Indian
subcontinent)
Black or African American (Person having origins in any of the black racial groups of Africa
Native Hawaiian/Other Pacific Islander (Person having origins in any of the original peoples of
Hawaii, Guam, Samoa or other Pacific Islands)
White (Person having origins in any of the indigenous peoples of Europe, North Africa, or Middle East)
GENDER
Female Male
VETERAN STATUS:
(Please check one if it describes your veteran status.)
Veteran of the Vietnam Era Special Disabled Veteran
Other Protected Veterans’ Recently Separated
Armed Forces Service Medal Veteran
Rev 11/2010
It is the policy of this College to provide equal employment opportunity to all employees and applicants for employment without
regard to race, color, religion, gender, sexual preference, national origin, age, disability, or any other protected characteristic. In
accordance with our voluntary affirmative action plan, we are required to keep records and perform certain analyses of our
applicant pools by race, ethnicity, and gender. The information requested on this form will be used for this purpose only and
will in no way affect the decision regarding your application for employment. This form will be kept confidential and
maintained separately from your application materials. Completion of this form is voluntary and is not a requirement of
consideration for employment.
