6. Race and Ethnicity Identification. The race and ethnic categories for federal statistics and administrative reporting are defined below. Please identify yourself
in terms of one or more of the following categories by marking the appropriate box(es).
4. People with Invisible (Hidden) Disabilities: Individuals who have a disability that is not visible to an onlooker. There are many disabilities such as
asthma, arthritis, heart disease, environmental illness, AIDS, chronic fatigue, psychiatric or mental illnesses, attention deficit hyperactivity disorder,
learning disabilities, and mild mental retardation.
(1) American Indian or Alaska Native
(3) Black or African American
7. Do you have a disability? (Voluntary)
Self-identification of disability status is essential for effective data collection and analysis. The information you provide will be used for statistical
purposes only. While self-identification is voluntary, your cooperation in providing accurate information is critical.
An Equal Opportunity Employer
APPLICATION FOR EMPLOYMENT (Cont'd)
General instructions: The information from this survey is used to help ensure that agency personnel practices meet the requirements of Federal law. Your
responses are voluntary. Please answer each of the questions to the best of your ability. Please print entries in pen. Be sure to read each item thoroughly
before completing this form.
2. Social Security Number
3. Position for which you are applying
5 (a). Is this a Student Program position?
(b). If "YES", do you intend to enroll or continue to be enrolled in a college
or university immediately after completing the program?
Note: Race is defined by the Equal Employment Opportunity Commission as follows:
Definition of a Disability: A person is disabled if he or she has a physical or mental impairment which substantially limits one or more major life
activities; has a record of such an impairment; or is regarded as having such an impairment. Those disabilities that are to be reported are listed below.
In the case of multiple impairments, choose the code which describes the impairment that would result in the most substantial limitation on this job.
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
4. Job Announcement Number
A person having origins in any of the original peoples of North America and South America (including Central
America), and who maintains tribal affiliation or community attachment.
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian
subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin,
regardless of race. This category includes the term "Spanish origin," as well as "Hispanic" or "Latino."
A person having origins in any of the black racial groups of Africa. This category includes terms such as
"Haitian" or "Negro" as well as "Black" or "African American."
A person having origins in any of the original peoples of a Hawaii, Guam, Samoa, or other Pacific Islands.
1. American Indian or Alaska Native
4. Hispanic or Latino
3. Black, or African American
5. Native Hawaiian or Other Pacific Islander
DS-1950 Page 5 of 5
If yes, please identify the disability using the codes below.
1. Name (Last, First, MI.)
Employment Data Self-Identification of Disability
1. Mobility Impairments: Individuals whose basic mobility, coordination, and balance, strength and endurance, and other aspects of body function are
affected by injuries or disease.
2. People Who Have Vision Impairments: Individuals who have either complete or partial loss of vision.
3. People Who Have Hearing Impairments: Individuals who may be deaf or hard of hearing.
5. People with Mental Retardation: Individuals who may not be able to think, reason or remember as well as others.
6. People with Psychiatric Disabilities: Psychiatric disabilities are diverse and include anxiety disorders, depression, bipolar disorders, schizophrenia,
and other conditions.
7. People with Muscular or Neurological Limitations: Muscular or neurological disabilities may affect motor ability and/or speech. You might observe
some involuntary or halting movement or limitation of movement in one or more than one appendage, as well as some lisping, indistinct speech or
flatness of tone due to lack of fine motor control of the tongue and lips. The severity and functional effects of the disability vary from person to person.
(4) Hispanic or Latino
(5) Native Hawaiian or Other Pacific Islander