NEO A&M Employment Appication Revised 07.01.145
NORTHEASTERN OKLAHOMA A&M COLLEGE - 200 I. STREET NE - MIAMI, OK 74354-6497
Memorandum for: Applicants
Voluntary Request for EEO Information
This information is requested of all applicants on a voluntary basis. This company is a government contractor. As
a result of this coverage, we must comply with Federal and State Equal Employment Opportunity record keeping
and reporting requirements. To respond to these obligations, we must request the following information. PLEASE
NOTE: Submission of this information is VOLUNTARY and refusal to provide it will not subject you to any adverse
action. The information you give us will be kept CONFIDENTIAL and away from your employment application.
The information may only be used in accordance with the provisions of applicable laws, executive orders and
regulations, including those that require the information to be summarized and reported to the federal government
Name: Job Applied for: ______________________________
I decline this opportunity respond to the questions listed below:
RACE/ETHNICITY - PLEASE CHOOSE ONE OF THE FOLLOWING:
American Indian or Alaskan Native: A person having origins in any of the peoples of North and South America (including Central America), and who
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.
Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of
White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa
Two or More Races:
Are you a U.S. Citizen? Yes No
Do you wish to declare yourself as mentally or physically disabled? Yes No
(If yes, please answer below.)
Description of Disability:
Skill or procedures you use or would intend to use to perform the job in spite of the disability
Accommodation which could be made that would enable you to perform the job properly and safely:
regulations may be informed.