Fillable Metropolitan State University of Denver Employee Data Sheet (Metropolitan State College of Denver)

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Metropolitan State University of Denver Employee Data Sheet (Metropolitan State College of Denver)

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Metropolitan State University of Denver
Employee Data Sheet
(2pages)
EMPLOYEE CONTACT INFORMATION AS OF:
(DATE)
First Name: MI: Last Name:
Social Security Number: Date of Birth:
Street Address: City, State, Zip:
Personal Email: Telephone Number: Cell Home
(Please circle)
EMERGENCY CONTACT INFORMATION:
Name of Contact Telephone Number:
If different from above:
Street Address: City, State, Zip:
VOLUNTARY INFORMATION SELF IDENTIFICATION:
Disclosure of self-identification information is voluntary and responses will not be used in a discriminatory
manner.
Gender: Citizenship Status: If Other than a United States Citizen
Female Male
Visa Type Country Visa Exp. Date
Ethnicity (select one):
Hispanic/Latino, Chicano, Cuban, Puerto Rican, Mexican American
Non-Hispanic/Latino
Race (regardless of answer above, select all that apply):
American Indian or Alaskan Native – A person having origins in any of the original peoples of North and South America
(including Central America), and who maintain cultural identification through tribal affiliation or community recognition.
Asian – 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.
Black or African-American – A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or
other Pacific Islands.
White, Anglo, Caucasian – A person having origins in any of the original peoples of Europe, Middle East, or North Africa.
Voluntary Self-Identification – Protected Veteran Status:
This employer is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as
amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take
affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active
duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans.
If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the
appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the
effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.
These classifications are defined as follows:
I am not a Veteran.
I am not a protected veteran.
A “disabled veteran” is one of the following:
A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but
for the receipt of military retired pay would be entitled to compensation) under laws administered by the
Secretary of Veterans Affairs; or
A person who was discharged or released from active duty because of a service-connected disability.
A “recently separated veteran” means any veteran during the three-year period beginning on the date of such
veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
Date of Separation:
An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S.
military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has
been authorized under the laws administered by the Department of Defense.
An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military,
ground, naval or air service, participated in a United States military operation for which an Armed Forces service
medal was awarded pursuant to Executive Order 12985.
Protected veterans may have additional rights under USERRA—the Uniformed Services Employment and Reemployment
Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may
be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for
the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training
Service (VETS), toll-free, at 1-866-4-USA-DOL.
EMPLOYEE SIGNATURE: DATE:
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Completed 18 September 2020

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