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Applicant Monitoring Form

All Applicants to Indiana University Kokomo are requested to complete the following questionnaire. Information provided is used in accordance with the University's Affirmative Action Program and in accordance with federal government requirements. This data is used solely to ensure compliance with these obligations. Information obtained from this form will be filed separately from applications and letters of recommendation submitted by candidates. This form will not go to the hiring department. No application will receive unfavorable consideration because an applicant has not provided this information.

INDIANA UNIVERSITY KOKOMO APPLICANT INFORMATION
Name:
Email:
Date:
Sex: Male Female
Age: under 40 over 40
Position Applied for (Please be specific):
Do you wish to identify your self as disabled? Yes No
RESIDENT STATUS
In accordance with federal law. IU employs only U.S. citizens and noncitizens' authorized to work in this country. IU will assist individuals needing working authorization to obtain the visa status necessary to be employed here. Please indicated your present status. 

U.S Citizen or Permanent Resident
Foreign National VISA type:
Are you Hispanic or Latino? Yes No
RACE/ETHNICITY (select one)
Please select the race/races you consider yourself (you may choose more than one). White
black or African American
American Indiana Or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Multiracial
VETERAN STATUS
Do you qualify for consideration under Indiana University Affirmative Action Plan for Veterans? If so, choose one:

Recently Separated Veteran
Disabled Veteran
Vietnam-era-Veteran
Armed Forces Services Medal Veteran
Other Protected Veteran

How did you learn of this position? (check all that apply)






:

 

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