Yes No
American Indian or Alaska Native
Asian
It is CSU policy to provide equal employment opportunity and to advance in employment all qualified individuals without regard to race, color,
religion, national origin, ancestry, physical or mental disability, medical condition, genetic information, marital status, sex, gender identity,
gender expression, age (over 40), sexual orientation, or protected veteran status.
The CSU is interested in monitoring the effectiveness of our recruitment efforts and the diversity of our workforce. This form has been developed
to assist us in these efforts and in collecting data that is required by University policies and State and Federal laws, including Executive Order
11246, the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, and Section 503 of the
Rehabilitation Act of 1973, as amended.
This form, and any data submitted on the form, will be kept separate from your personnel file and will not be accessible by anyone involved with
making recommendations or decisions regarding your employment. While your reply will be most helpful to us in reporting accurate data,
completing this form is entirely voluntary; refusal to complete the form will not adversely affect your employment.
If you have a disability and need accommodation, please contact the Human Resources or Faculty Affairs Office to begin an interactive
discussion to identify and provide you a reasonable accommodation.
A person having origins in any of the original peoples of North and South
America (including Central America) who maintains cultural identification
through tribal affiliation or community attachment.
CATEGORY DEFINITION OF CATEGORY
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
Japanese
Native Hawaiian or Other Pacific Islander
White
Vietnamese
Laotian
Other Asian
A person having origins in any of the black racial groups of Africa.
A person having origins in any of the original peoples of Hawaii, Guam, Samoa,
or other Pacific Islands.
Guamanian
Samoan
Hawaiian
Other Native Hawaiian or
Other Pacific Islander
A person having origins in any of the original peoples of Europe, the Middle
East, or North Africa.
Ethnicity. Are you Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish
culture or origin, regardless of race.)
Race. Regardless of your answer to the above question, you may select one or more of the following categories that apply to
you:
VOLUNTARY SELF-IDENTIFICATION FORM FOR EMPLOYMENT APPLICANTS
Filipino
Korean
Chinese
Cambodian
Asian Indian
Gender. Please select one of the following:
Male Female
