WESTERN IOWA TECH COMMUNITY COLLEGE
EMPLOYMENT POLICY STATEMENT
Western Iowa Tech embraces the concept of nondiscrimination in all areas of human and personnel relations. Equal opportunity
in recruitment, in employment, and in advancement is guaranteed students, potential students, applicants for employment, and
all college personnel regardless of race, creed, color, gender, national origin, religion, age*, disability, sexual orientation, gender
identity or other protected basis as dened by law.
*Within areas covered by federal law or regulations.
EQUAL EMPLOYMENT OPPORTUNITY SURVEY
The following information is necessary for Western Iowa Tech to evaluate its hiring practices and to prepare reports requested by
law for the state and federal government. The information will be condential and will not be used to make a decision about your
employment. Your cooperation by providing the information on a voluntary basis will be appreciated.
Date:__________________
POSITION APPLIED FOR _________________________________________________________________________________
NAME [including former name(s)]
____________________________________________________________________________________
Last First Middle Former
BIRTH DATE ________/________/________ SOCIAL SECURITY NO. ________/________/________
SEX: Male ________ Female ________
ETHNICITY DISABILITY MILITARY STATUS (please check all that apply)
_____ Hispanic/Latino _____ Not Disabled _____ Disable Veteran Other Than Vietnam
_____ Non Hispanic/Latino _____ Ambulatory/Mobility _____ Non-Veteran
_____ Visual _____ Veteran Other Than Vietnam
RACE
_____ Hearing _____ Disabled Veteran Vietnam Era
_____ American/Alaska Native
_____ Mental/Psychological _____ Spouse of Deceased Veteran
_____ Asian
_____ Multiple Handicaps _____ Vietnam Era Veteran
_____ Black or African American
_____ Other
_____ Hawaiian/Pacic Islander
_____ White
Western Iowa Tech Community College, Sioux City, Iowa, in compliance with Titles VI and VII of the Civil Rights Act of 1964, Title
IX of the Education Amendments of 1972 (45 CFR86), Sections 503 and 504 of the Rehabilitation Act of 1973, and the Americans
With Disabilities Act, does not discriminate on the basis of race, creed, color, gender, national origin, religion, age*, disability, sexual
orientation, gender identity or other protected basis as dened by law in any of its policies, procedures, or practices; nor does
the College, in compliance with the Age Discrimination in Employment Act of 1967 and Section 402 of the Vietnam Era Veterans
Readjustment Act of 1974, discriminate against any employee or applicants for employment on the basis of age or because they are
disabled veterans or veterans of the Vietnam Era. This nondiscrimination policy covers admissions, access, and treatment in the
College’s programs and activities, and application for and treatment in district employment.
In conformance with College policy and pursuant to Executive Order 11246 and 11375, Section 503 of the Rehabilitation Act of
1973, and Section 402 of the Vietnam Era Veterans Readjustment Act of 1974, the college is an afrmative action/equal opportunity
employer.
Inquiries regarding the College’s equal opportunity policies may be directed to the Afrmative Action/EEO and Title IX Compliance
Ofcer, Western Iowa Tech Community College, 4647 Stone Avenue, P.O. Box 5199, Sioux City, Iowa 51102-5199 (Phone 712-274-
6400). In addition, inquiries may be directed to the Sioux City Human Rights Commission, 355 Orpheum Electric Building, Sioux
City, Iowa 51102; the Iowa Civil Rights Commission, 211 East Maple Street, Des Moines, Iowa 50319; the Director of the Ofce of
Civil Rights, Department of Labor, Washington, DC 20201.
Rev. 12/2011/HR
