Affirmative Action Program Data
Human Resources  650-3774

#New Form

The University is required to collect the following information from all employees for compliance with state and federal reporting requirements.  This information will be kept confidential and will be used in conjunction with the University's affirmative action program in compliance with Federal Executive Order 11246, 38 U.S.C. 4212, the Rehabilitation Act of 1973, the Veterans Employment Opportunities Act of 1998 and Washington State Executive Order 93-07 and RCW 41.06.150.  WWU is a Government contractor subject to the Vietnam Veterans' Readjustment Assistance Act of 1974, as amended, which requires Government contractors to take affirmative action to employ and advance in employment qualified special disabled veterans, veterans of the Vietnam era, recently separated veterans, and other protected veterans. WWU is also subject to section 503 of the Rehabilitation Act of 1973, as amended, which requires Government contractors to take affirmative action to employ and advance in employment qualified individuals with disabilities. WWU takes such required affirmative action through its recruitment and outreach program to veterans and persons with disabilities.  Employees who do not complete this information will not be treated adversely.

First Name:

Last Name:

Department:
1. Are you Hispanic or Latino? (See definitions.)  No Yes

2. With which race do you identify?  (See definitions.  Check all that apply.)
  American Indian or Alaska Native
  Asian
  Black or African American
  Native Hawaiian or other Pacific Islander
  White

3. If you checked more than 1 box in 2) above, please specify which race you prefer for 
 
affirmative action purposes:  

4. Gender:  Female Male

5. Age: Are you age 40 or older?  No Yes

6. Disability:
Federal Affirmative Action Criteria For Disability Status:
  Do you have a physical or mental impairment which substantially limits one or more major life activities?  Or, do you have a record of such an impairment?  Or, are you regarded as having such an impairment? ( See definition.) No Yes
 
  Washington State Affirmative Action Criteria For Disability Status:
  Do you have a disability as defined by WA law?  In WA, "disability" means the presence of a sensory, mental, or physical impairment that: is medically cognizable or diagnosable; or exists as record or history; or is perceived to exist whether or not it exists in fact.  A disability exists whether it is temporary or permanent, common or uncommon, mitigated or unmitigated, or whether or not it limits the ability to work generally or work at a particular job or whether or not it limits any other activity.
 
No Yes

7. Veteran Status: (See definitions.  Check all that apply.)
  Special Disabled Veteran
  Vietnam Era Veteran
 
Other Protected Veteran (specify organization and date)
  Disabled Veteran
  Armed Forces Service Medal Veteran
Date of Discharge or release from active duty in the US military, ground, naval or air service?
   
The submitter may optionally enter their email address below. Press SUBMIT to send it.
Your Email Address: