Voluntary applicant data sheet form for regular employees Northern Arizona University is subject to certain nondiscrimination and affirmative action record keeping and reporting requirements which require the employer to invite applicants to voluntarily self-identify their race/ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be treated in a confidential manner, and will be used to assist in fulfilling the university’s federal and state statistical reporting and affirmative action program monitoring requirements. For civil rights monitoring and enforcement purposes only, all race/ethnicity information will be collected and reported in the seven categories identified below. The definitions for each category have been established by the federal government. Thank you very much for your consideration and assistance.Position applying for * Required Department * Required Date * Required MM slash DD slash YYYY Name as it appears on application * Required First Last Job Vacancy Number (appears at top of job description) * Required Email * Required Contact phone * RequiredMailing address * Required Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How did you hear about this job? * Required Word of mouth Internet search Job posting Advertisement (please name the publication or newspaper below): Other (please list below): Name of Publication * Required Other (more detail) * Required Invitation to Self-Identify If you need reasonable accommodation to participate in the hiring process, please contact the Disability Resources office at (928) 523-8773 or email DR@nau.edu.Sex * Required Male Female I choose not to self-identify Race/Ethnicity Please review and respond to both questions. The categories listed below are the only options currently available for federal reporting purposes.Do you consider yourself to be Hispanic/Latino? (A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race). * Required Yes No In addition to responding to the question above, select one or more of the following racial categories to describe yourself: * Required American Indian or Alaskan Native - A person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation or community identification. Black or African American (not of Hispanic origin) - A person having origins in any of the Black racial groups of Africa. Asian - A person having origins in any of the peoples of the Far East, Southeast Asia, the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Native Hawaiian or Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White (not of Hispanic origin) - A person having origins in any of the original people of Europe, Northern Africa, or the Middle East. choose to not self-identify Veteran Status Northern Arizona University is also subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows: A “disabled veteran” is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability. A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service. An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985. If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.Veteran status identification * Required I IDENTIFY AS ONE OR MORE OF THE CLASSIFICATIONS OF PROTECTED VETERAN LISTED ABOVE I AM NOT A PROTECTED VETERAN Protected veterans may have additional rights under USERRA – The Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor’s Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL. Northern Arizona University bases decisions on employment solely upon the individual’s qualifications for the position being filled. NAU recruits, hires and promotes for all job classifications without regard to race, sex, color, religion, age, national origin, disability, veteran status, sexual orientation, or gender identity. Voluntary Self-Identification of Disability Form CC-305 OMB Control Number 1250-0005 Expires 04/30/2026 Page 1 of 2 Why are you being asked to complete this form? We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years. Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. How do I know if I have a disability? A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to: •Alcohol or other substance use disorder (not currently using drugs illegally)•Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS•Blind or low vision•Cancer (past or present)•Cardiovascular or heart disease•Celiac disease•Cerebral palsy•Deaf or serious difficulty hearing•Depression or anxiety •Diabetes•Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders•Epilepsy•Epilepsy or other seizure disorder•Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome•Intellectual disability•Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD•Missing limbs or partially missing limbs•Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports•Nervous system condition for example, migraine headaches, Parkinson’s disease, Multiple sclerosis (MS)•Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities•Partial or complete paralysis (any cause)•Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema•Short stature (dwarfism)•Traumatic brain injury Please check one of the boxes below: * Required YES, I HAVE A DISABILITY, OR HAVE HAD ONE IN THE PAST NO, I DON'T HAVE A DISABILITY AND HAVE NOT HAD ONE IN THE PAST I DON'T WANT TO ANSWER PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to the collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete Reasonable Accommodation Notice Completion of this form is not a request for accommodation. If you would like to request an accommodation, please contact the Disability Resources office at 928-523-8773 or email DR@nau.edu.PhoneThis field is for validation purposes and should be left unchanged.