Idaho State University
Affirmative Action Identification
Temporary or Student Employees
IDAHO STATE UNIVERSITY ASKS APPLICANTS TO VOLUNTEER THE FOLLOWING INFORMATION FOR OUR
AFFIRMATIVE ACTION PROGRAM; THIS INFORMATION IS HELD IN CONFIDENCE BY THE AFFIRMATIVE ACTION
OFFICE AND IS NOT ROUTINELY SUPPLIED TO ANY OTHER UNIVERSITY DEPARTMENT. YOUR COOPERATION IS
GREATLY APPRECIATED.
PERSONAL DATA
Temporary Employee (non-student) Student Employee
Employee Name (print or type legal name):
Department: Date of Employment:
Male Female Birth date:
Disabled
AN INDIVIDUAL WHO (1) HAS A PHYSICAL OR MENTAL IMPAIRMENT WHICH 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.
RACE/ETHNIC ORIGIN (Check only one)
American Indian/Alaskan Native
A PERSON HAVING ORIGINS IN ANY OF THE ORIGINAL PEOPLES OF NORTH AMERICAN AND WHO
MAINTAINS CULTURAL IDENTIFICATION THROUGH TRIBAL AFFILIATION OR COMMUNITY
RECOGNITION.
Asian/Pacific Islander
A PERSON HAVING ORIGINS IN ANY OF THE ORIGINAL PEOPLES OF THE FAR EAST, SOUTHEAST
ASIA, THE INDIAN SUB-CONTINENT, OR THE PACIFIC ISLANDS. THIS AREA INCLUDES, FOR
EXAMPLE, CHINA, JAPAN, KOREA, THE PHILIPPINE ISLANDS AND SAMOA.
Black (Not of Hispanic origin)
A PERSON HAVING ORIGINS IN ANY OF THE BLACK RACIAL GROUPS OF AFRICA.
Hispanic
A PERSON OF MEXICAN, PUERTO RICAN, CUBAN, CENTRAL OR SOUTH AMERICAN OR OTHER
SPANISH CULTURE OF ORIGIN, REGARDLESS OF RACE.
White (Not of Hispanic origin)
A PERSON HAVING ORIGINS IN ANY OF THE ORIGINAL PEOPLES OF EUROPE, NORTH AFRICA, OR THE
MIDDLE EAST.
VETERAN STATUS (Check all that apply)
Disabled Veteran
A VETERAN WITH A DISABILITY THAT WAS INCURRED IN THE LINE OF DUTY, OR A DISABILITY
RATED AT 30% BY THE VETERANS ADMINISTRATION.
Vietnam Veteran
CITIZENSHIP STATUS (Check only one)
U.S. Citizen
Permanent U.S. Resident
Other, please explain
RECRUITMENT SOURCE (Check all that apply)
Chronicle of Higher Education Morning News (Blackfoot)
Higheredjobs.com Other, please explain
Idaho State Journal Post Register
Idaho State University Website Salt Lake Tribune
Idaho Statesman Times News (Twin Falls)
Trade publication/Web site
