Faculty Handbook

Pre-Employment Inquiry

Dear Applicant:

We have received your application for a position at Western Connecticut State University. Your resume has been referred to the appropriate search committee and, if you are selected for further consideration, you will be contacted for an interview.

In compliance with federal and state regulations, Western Connecticut State University is required to collect and maintain data on the race, sex, and ethnic identity of all applicants for employment. Your responses are strictly voluntary and will help in implementing Western’s Affirmation Action Program. If you choose not to answer any of the questions, you will not be subject to adverse effects; however, we urge you to do so and assure you that this form is confidential. Any use of this material for purposes not connected with affirmative action or any use by unauthorized persons is punishable under the law.

Please complete the information below and return it in the enclosed envelope to our Chief Diversity Officer. Thank you.

Affirmative Action Data Sheet

Name_________________________________________________________Sex: _____Male _____Female
Race or National Origin (check one)    
  [ ] Black (not of Hispanic origin)-all persons having origins in any of the Black racial groups of Africa
  [ ] Hispanic–all persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish
    culture or origin, regardless of race
  [ ] White (not of Hispanic origin)-all persons having origins in any of the original peoples of Europe,
    NorthAfrica, or the Middle East
  [ ] American Indian or Alaskan Native-all persons having origins in any of the original peoples of North
    America, and who maintain cultural identification through tribal affiliation or community recognition
  [ ] Asian or Pacific Islander-all persons having origins in any of the original peoples of the Far East,
    Southeast Asia, the Indian Subcontinent, or the Pacific Islands. The area includes, for example, China,
    Japan, Korea, the Philippine Islands, and Samoa.    
    These definitions are provided by the Equal Employment Opportunity Commission, Washington, D.C.
    Position for which you are applying (circle one): Adjunct Faculty Position Other
    How were you referred to us:    
  [ ] Newspaper or journal advertisement    
    Specify which one(s)____________________________________________  
  [ ] Professional Associations    
    Specify which one(s)____________________________________________  
  [ ] A Colleague (or word of mouth)    
  [ ] Position announcement sent to your campus    
  [ ] Other (please specify)___________________________________________  
Search Number:  __________________________________    


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