AFFIRMATIVE ACTION QUESTIONNAIRE

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This information is being gathered for affirmative action under Section 503 of the Rehabilitation Act of 1973 . The information requested is voluntary and will be kept confidential. An applicant will not be subject to any adverse treatment for refusing to complete the questionnaire. 

The purpose of this section is to assist in monitoring Affirmative Action Programs and to aid in complying with any required Government record keeping or periodic reporting. This information is not part of your employment application, and wi ll not be considered in the employment/selection process. If you choose to provide the information, please complete the following: 

Male
Female

RACE/ETHNICITY 

Yes
No
American Indian or Alaskan Native (Not Hispanic or Latino)
Asian (Not Hispanic or Latino)
Black or African American (Not Hispanic or Latino)
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
White (Not Hispanic or Latino)
Two or More Races (Not Hispanic or Latino)

VETERANS/U.S. MILITARY STATUS

Special Disabled Veteran
  1. A veteran who is entitled to compensation under laws administered by the Dept. of Veterans Affairs for a disability (a) rated at 30% or more, or (b) rated at 10% or 20% if it has been determined that the individual has a serious employment disability; or 
  2. A veteran who was discharged or released from active duty because of a service-connected disability. 
Vietnam Era Veteran
  1. Served in the military, ground, naval or air service of the U.S. on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred: (a) in the Republic of Vietnam between 02/28/1961, and 05/07/1975; or (b) between 08/05/1964, and 05/07/1975, in all other cases; or 
  2. Was discharged or released from active duty for a service connected disability if any part of such active duty was performed: (a) in the Republic of Vietnam between 02/28/1961, and 05/07/1975; or (b) between 08/05/1964, and 05/07/1975, in all other cases.
Other Protected Veteran
  1. Other protected veteran is defined as a veteran who served in the military, ground, naval or air service of the U.S. on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized. 
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