UNIVERSITY OF ILLINOIS
OFFICE OF EQUAL OPPORTUNITY AND ACCESS
EQUAL EMPLOYMENT OPPORTUNITY INFORMATION REQUEST FORM


Name of Applicant:
Search Number:
  Enter Search Number and click button to fill in information below
Banner College/Department Code Number:
Name of Department: 
Title of Position Applied for


TO THE APPLICANT:

The University of Illinois at Urbana-Champaign is required by Federal law to request and maintain the following data on applicants for employment: racial/ethnic and gender identity. These data provide the University of Illinois and the Federal government with information necessary to monitor the University's compliance with Equal Employment Opportunity requirements.

Please complete this form and click on the submit button. If you have problems submitting this form, please contact the Office of Equal Opportunity and Access at 217-333-0885. Submission of the information requested is voluntary, and failure to provide it will not subject you to any adverse treatment.

Note: This form will not be kept with your application nor considered in the employment decision. Additional application materials should not be sent with this form, but sent directly to the department to which you have applied.



GENDER: Female Male

RACIAL/ETHNIC DATA: Please click on the box to the left of the group below with which you identify.
American Indian or Alaskan Native.   Persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition. (1)
White, not of Hispanic origin.   Persons having origins in any of the original peoples of Europe, North Africa, or the Middle East. (2)
Black, not of Hispanic origin.   Persons having origins in any of the black racial groups of Africa. (3)
Asian or Pacific Islanders.   Persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands.   This area includes, for example, China, Japan, Korea, the Philippine Islands, and Samoa. (4)
Latino/a.   Persons of Mexican, Puerto Rican, Cuban, Central and South American, or Spanish culture or origin, regardless of race. (5)
Unknown.

HOW DID YOU LEARN OF THIS POSITION OPENING?
Professional Conference (1)
Chronicle of Higher Education (3a)
Wall Street Journal  (3b)
Internal University of Illinois at Urbana-Champaign (UIUC) Job Posting (4)
Personal Contact by UIUC staff (includes referral and nomination) (5)
Daily Illini; Inside Illinois; Online Employment Center;  Job Registry (6)
Champaign-Urbana News Gazette (7a)
Chicago Tribune (7b)
External Posting (on other campuses) (9)
Professional Journal please specify: (2)
Other Newspaper please specify: (8)
Other please specify: (10)



This page maintained by the University of Illinois
Office of Equal Opportunity and Access

For assistance, please email oeoa@uiuc.edu