Pre-employment Offer to Self-Identify
Have you ever been employed by New Mexico Tech? ____yes ____no
How do you describe yourself? (check one)
_____White (Not of Hispanic Origin): Persons having origins in any of the original peoples of
Europe, North Africa or the Middle East.
_____Black (Not of Hispanic Origin): Persons having origins in any of the Black racial groups.
_____Hispanic: Persons of Mexican, Puerto Rican, Cuban, Central or South American or any
other Spanish Culture origins.
_____Asian or Pacific Islander: Persons having origins in any of the original peoples of the Far
East, Southeast Asia, the Indian Subcontinent, or Pacific Islands. This area includes for example,
China, Japan, Korea, the Philippine Islands, and Samoa.
_____American Indian or Alaskan Native: Persons having origins in any of the original peoples
of North America, and who maintain cultural identification through tribal affiliation or
Gender _____Female _____Male
Are you a Disabled Veteran of the United States Military? _____yes _____no
Are you a protected Veteran protected by VEVRAA? _____yes _____no
Are you an active duty wartime or campaign badge Veteran? _____yes _____no
New Mexico Institute of Mining & Technology, as a standing policy, does not discriminate
against individuals because of their race, color, religion, creed, age, sex, national origin, physical
or mental handicap, disability, or status as a qualified protected veteran. Any discriminatory
action can be a cause for disciplinary action. This policy applies to all Institute programs and
facilities including, but not limited to admissions, educational programs, and employment. This
contractor and subcontractor shall abide by the requirements of 41 CFR 60-300.5 (a). This
regulation prohibits discrimination against qualified protected veterans, and requires affirmative
action by covered prime contractors and subcontractors to employ and advance in employment
qualified protected veterans. Discrimination is prohibited by Titles VI and VII of the Civil Rights
Act of 1964, Title IX of the Educational Amendments of 1972, sections 503 and 504 of the
Rehabilitation Act of 1973, age Discrimination in Employment Act Amendments of 1978,
Americans with Disabilities Act, New Mexico Human Rights Act, and other federal and state
regulations. Coordination of the compliance efforts of New Mexico Institute of Mining &
Technology with respect to these laws and regulations is under the direction of the Director of
Affirmative Action and Compliance Programs, 801 Leroy Place, Socorro, New Mexico 87801.