THE CLAREMONT COLLEGES

 

APPLICANT IDENTIFICATION RECORD

 

Each of The Claremont Colleges is an Affirmative Action/Equal Opportunity Employer.  We are required to compile information concerning the race, sex, disabled and veteran’s status of each applicant.  If returned, the form will be separated from the application and placed in a different file.

 

Date:                                                   Position Applied For:                                                 

 

Gender:           Male o                        Female o

 

Please indicate the group that most closely identifies you.

 

o    Asian/Pacific Islander

o    Black/non Hispanic

o       American Indian/Alaska Native

o    Other_____________________

o       White (not of Hispanic Origin)

o         Hispanic

o    Choose not to identify

 

Do you consider yourself disabled, defined in Section 504 in the Rehabilitation Act of 1973, as:  Any person who (I) has a physical or mental impairment which substantially limits one or more major life activities, (II) has a record of such an impairment, or (III) is regarded as having such an impairment?   o  Yes                        o  No

 

If yes, explain:                                                                                                                       

 

                                                                                                                                               

Are you a Disabled Veteran, defined as having a 30% or more disability rating and receiving VA disability compensations, or released from active duty due to disability incurred or aggravated in the line of duty?  o  Yes                        o  No

 

If yes, explain:                                                                                                                       

 

                                                                                                                                               

 

Are you a Vietnam-era veteran who served on active duty between January 1, 1959 and December 31, 1969?      o  Yes                  o  No

How did you come to apply for a job at Claremont McKenna College? (Check all that apply)

 

o         Employee

o         EDD Employment Services

o         Community Agency

o         Former Employee

o         Former Student

o         Student Spouse

o         Advertisement (if so, which publication):                _____ 

o         Recruitment

o         Walk-in

o    Association Website (if so, which one):_____________________

o    CMC Website

o    Other _____________________

o         Employment Opportunities Posting (if so, where):              _____