Equal Opportunity Office

"Affirmative Action Compliance Program Information"

Applicant Information Form

Eastern Kentucky University is committed to the principles of equal opportunity and affirmative action. The University requests your voluntary completion of this form. This information is optional and will be kept separately from your application and all other data. It will be used for analysis purposes related to the University's Affirmative Action Compliance Program. This information will not be used to discriminate against or to show preference to any applicant in the hiring decision. Eastern Kentucky University is prohibited by law from discrimination on the basis of age, race, color, religion, sex, sexual orientation, disability, national origin or Vietnam Era, Special Disabled Veteran or other eligible veteran status in its selection procedures. Please return this form to Eastern Kentucky University, Equal Opportunity Office, 521 Lancaster Avenue, Coates CPO 37A, Richmond, Kentucky 40475-3102. A postage-paid business-reply envelope is enclosed for your use.

A copy of the Eastern Kentucky University Annual Security Report and the daily crime log is available for viewing. Information on viewing these websites and obtaining a copy of the report can be found at http://www.publicsafety.eku.edu/acr/.

If Department is mailing this to applicant, please complete items 1-4 prior to mailing this form to the applicant.*
1. Position Title Applied For:
2. Position Number:
3. Department:
4. College/Division:

*Applicant, if items 1-4 have not been completed, please complete items 1-4 to the best of your knowledge.
5. Today's Date:	(mm/dd/yyyy)

6. Gender:	Female	Male
7. Vietnam Era Veteran:	Yes	No
8. Other Eligible Veteran*:	Yes	No
*served active duty during a war or in a campaign or expedition for which a campaign badge has been authorized

9. Race/Ethnicity:	10. How did you learn of this position?
American Indian or Alaska Native Asian/Pacific Islander Black Hispanic White	Friend/Relative EKU Employee EKU Human Resources EKU Website Other Internet Sites Lexington Herald-Leader Richmond Register Chronicle of Higher Education Diverse Issues Affirmative Action Register Professional Journal/Newsletter, specify* Other Publication, specify* Job Fair Other, specify* *Specifications

Eastern Kentucky University is an Equal Opportunity/Affirmative Action Employer and Education Institution