Last Updated 11/14/2013
Voluntary Self-Identification Form
We are requesting that you complete this self-identification section for the purpose of statistical analysis
only. This information will neither enhance nor detract from your opportunity for employment with the
University. This form and its data will be kept separate from your application and will not be accessible by
anyone involved in making recommendations or decisions regarding hiring for this position.
Name: ____________________________________________________________________________________
College: ___________________________________________________________________________________
Department: _______________________________________________________________________________
Tenure Track Professor Adjunct/Lecturer
Please indicate your ethnicity by selecting the most appropriate code.
1) Ethnicity/Race:
a) Are you Hispanic or Latino?
Yes
No
b) Regardless of your answer to Question 1, you may select one or more of the following categories that
apply to you:
American Indian or Alaska Native
Asian
Chinese
Japanese
Korean
Vietnamese
Filipino
Asian Indian
Laotian
Cambodian
Other Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
2) Gender
Female
Male
How did you learn about this vacancy?
Advertisement What source ______________________________________________________________
Campus Employee
Person Off Campus
Self Inquiry
Other: __________________________________________________________________________________
PLEASE SUBMIT TO jobopenings@calstatela.edu
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