MONTANA STATE UNIVERSITY-BILLINGS
APPLICANT SURVEY
EQUAL EMPLOYMENT OPPORTUNITY FORM
This is a voluntary confidential form which is kept separate from your application. Montana State University-
Billings, as a federal contractor, uses this procedure for obtaining applicant flow information, which is analyzed to
determine if our selection process ensures equal employment opportunity. We appreciate your cooperation in
providing the following information, however, submission of this information is voluntary.
Position Applying For:
Department:
Name:
Date of Birth:
SEX: Female Male
RACE: (check one)
HISPANIC or LATINO – A person of Cuban, Mexican, Puerto Rican, Central and South American, or other
Spanish culture or origin, regardless of race.
WHITE (Not of Hispanic or Latino) – A person having origins in any of the original peoples of Europe, North
Africa, or the Middle East.
BLACK or AFRICAN AMERICAN (Not of Hispanic or Latino) – A person having origins in any of the
black racial groups of Africa.
NATIVE HAWAIIAN or OTHER PACIFIC ISLANDER (Not of Hispanic or Latino) – A person having
origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.
ASIAN (Not of Hispanic or Latino) – A person having origins in any of the original peoples of the Far East,
Southeast Asia, the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea,
Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
AMERICAN INDIAN or ALASKAN NATIVE (Not of Hispanic or Latino) – A person having origins in any
of the original peoples of North and South America (including Central America) who maintain cultural
identification through tribal affiliation or community attachment.
TWO OR MORE RACES (Not of Hispanic or Latino) – All persons who identify with more than one of the
above five races.
Veteran's Preference. MSU-Billings complies with the Montana Veteran's Employment Preference Act and
provides preference in employment to eligible veterans, disabled veterans and certain eligible relatives as specified
in the Act. Applicants seeking to claim this preference should contact the Human Resources Office, 310 McMullen
Hall, 1500 University Drive, Billings, MT, 59101-0298, (406)657-2278 (voice/TDD), before the screening or
closing date for applications.
Accommodation for Persons with Disabilities. The University is committed to make reasonable accommodation for
any known disability that may interfere with an applicant's ability to compete in the selection process or an
employee's ability to perform the essential functions of the job. If you have such a disability and would like to
request accommodation, please contact our office.
Verification of Employment Eligibility. MSU-Billings employs only U.S. citizens and aliens lawfully authorized to
work in the United States. Pursuant to the Immigration Reform and Control Act of 1986, we require all new
employees to complete the Employment Eligibility Verification Form (I-9) which documents their identity and
employment eligibility. The I-9 form must be completed and the appropriate documentation provided within three
days of the date employment commences.
How did you learn about this opening?
Newspaper Advertisement (Please specify):
Announcement Flyer (Please specify):
Professional Journal (Please specify):
The Chronicle of Higher Education
Invited to Apply by (Please specify):
Other (Please specify):
Please e-mail or send completed form to
employment@msubillings.edu or MSU-Billings, Human
Resources Office, 310 McMullen Hall, 1500 University Drive, Billings, MT, 59101-0298
MONTANA STATE UNIVERSITY-BILLINGS IS AN EEO/AA/ADA EMPLOYER
