APPENDIX 22 INVITATION TO SELF-IDENTIFY

AA-1 Revised: 01/11/11

APPENDIX 22

RETURN TO THE AFFIRMATIVE ACTION OFFICE

214 Anderson Hall
Kansas State University
Manhattan, KS 66506

Federal and State laws and regulations require Kansas State University to invite applicants to voluntarily self identify. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment nor adversely affect your candidacy. The information provided on this form will be used only in ways that are consistent with the Title VII, Vietnam Era Veterans’ Readjustment Assistance Act of 1974, the Americans with Disabilities Act Amendments Act, and Executive Order 11246. It will not be included in your application or personnel file. The information is considered confidential and will be used by the Office of Affirmative Action for the purpose of establishing protection under the law, determining appropriate accommodations, administering first aid, and compliance with laws and regulations.

To locate the position title, please visit http://www.k-state.edu/affact/Opportunities/unclass.htm. The position title is bolded and listed after the position number and department.
To locate the requisition number, please visit http://www.k-state.edu/affact/Opportunities/unclass.htm. The requisition number is the four digit number preceding the title of the position.
  1. Gender:
  2. Race/Ethnicity:
  3. Disability
    Individual with a disability means any person who: (a) has a physical or mental impairment which substantially limits one or more major life activities, such as, reading, walking or speaking; (b) has a record of such impairment; or (c) is regarded as having such an impairment.

    Please check all that apply.
    Are you an individual with a disability?
    Please indicate whether you will need accommodations during the interview process due to a disability.
    If so, please describe accommodations needed due to a disability:
  4. Veteran Status
    Please check all that apply.
    Are you a disabled veteran?
    Are you a recently separated veteran (three years or less)?
    Are you an Armed Forces Service Medal Veteran?
    Are you a Vietnam Era Veteran (between August 5, 1964, and May 7, 1975)?
    If Yes, date of discharge:
  5. How did you learn of this position?