Self Identification Form - John A. Logan College

John A. Logan wishes to comply voluntarily with various laws and regulations that require us to file annual statistical reports on applicants for employment. In addition, we want to comply voluntarily with the multiple laws and regulations that protect disabled veterans and veterans who served on active duty during the Vietnam era for more than 180 days.

Submission of this information by you is voluntary. Please be assured that you will not be subject to adverse treatment if you do not provide the requested information.

Position for which you are applying

Are you responding to an advertisement?

Yes
No

Applicants Identifying Themselves as Disabled

Do you have any physical condition or disability that may limit your ability to perform the positions you are applying for?

Yes
No

If yes, do you possess, or can we provide, any special methods, skills, or procedures that might qualify you for a position you might not otherwise be able to do because of your disability?

You are not required to provide the above information concerning a disability. If you do, it will be kept confidential, with the following exceptions:

Supervisors may be informed if accommodation is necessary or if your work duties are restricted.
Government representatives may be provided information in compliance with various laws and regulations.

Applicants Identifying Themselves as Veterans

Are you a veteran?

Yes
No

Are you a disabled veteran?

Yes
No

Are you a Vietnam-Era veteran who served on active duty for more than 180 days during the Vietnam Era?

Yes
No

Gender

Male
Female
Nonbinary

Equal Employment Opportunity (EEO) Classification

RACE/ETHNICITY:

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
Native American or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.
Two or more races (Not Hispanic or Latino): All persons who identify with more than one of the above five races.
I do not wish to disclose.

Name (optional)

First

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