Fillable Applicant Ethnic Disclosure Form 4 (University of Hawaii at Hilo)

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Applicant Ethnic Disclosure Form 4 (University of Hawaii at Hilo)

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Please return the completed form to the EEO/AA Office, 200 W. Kawili St., Hilo, HI 96720
CONFIDENTIAL
_____________________________________________________________________________
University of Hawai‘i, Hilo
Applicant Voluntary Self-Identification
Your response to this request is strictly voluntary. If you do not complete the survey form, this will in no way
adversely affect your application. As a safeguard, any information you provide will be submitted directly to the
campus Equal Employment Opportunity and Affirmative Action Officer. It will not be included in your employment
application. The information will be used for reporting purposes and will be handled in a confidential manner, in
accordance with state and federal law and University policy.
Last Name First Name Middle Initial Position Title Position No.
Department
Gender:
Female Male
Are you Hispanic/Latino?
Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin regardless of race.
yes no
Please select one or more racial categories to describe yourself:
White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa (e.g., persons
who identify as Portuguese, German, Lebanese, Arab, Egyptian).
American Indian or Alaska Native - A person having origins in any of the original peoples of North, Central, and
South America and who maintains tribal affiliation or community attachment.
Black or African American - A person having origins in any of the black racial groups of Africa.
Native Hawaiian/Part Hawaiian or Other Pacific Islander:
Native Hawaiian or Part Hawaiian
Guamanian or Chamorro
Micronesian (not Guamanian or Chamorro)
Samoan
Tongan
Other Pacific Islander
Asian:
Chinese Laotian
South Asian and Asian Indian: A person having origins in any
of the original peoples of the Indian subcontinent (e.g., India,
Pakistan, Afghanistan, Bangladesh, Bhutan, Nepal, Sri Lanka).
Filipino Thai
Japanese Vietnamese Other Asian
Korean
Note: Race/ethnic designations as used by the U.S. Equal Employment Opportunity Commission (EEOC) do not denote scientific definitions of
anthropological origins. Self-identification is the preferred method of obtaining this information.
(EEO/AA) rev. 07/09
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Applicant Ethnic Disclosure Form 4 (University of Hawaii at Hilo)

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Completed 23 July 2020

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