ࡱ> q` HWbjbjqPqP t\::)TBBB$f5555,5fC,n6(6666888BBBBBBB$DhKGC]Bd;g8^8d;d;C66qC<<<d;X86B6B<d;B<<*B<6b6 O5;L<<,C0C<G<jG<GB<@8W9h<9T:Q888CCr<888Cd;d;d;d;fff$15fff5fff  Please do not write in shaded area GRAMBLING STATE UNIVERSITY  APPLICANT DATA COMPLIANCE FORM (Instructions on page 2) Section I: For Person Hired DRAFT Effective Name of SSN of Highest Date %%%%%%%%%%%%%%%%%% Hiree %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Hiree %%%%%%%%%%%%%%%%%%%% Race %%%%%%%%% Sex %%%%%%%%% Degree %%%%%%%%%%%%% Department %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Unit %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Job Title %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Section II: Please do not write in shaded area. Applicant Name (Last,First,M.I.) R S D O  Applicant Name (Last,First,M.I.) R S D O ADVANCE \x558Code Explanations: See Reverse Side R= Race/Ethnic Group W = White (non-hispanic) B = Black (non-hispanic) I = American Indian or Alaskan Native H = Hispanic A = Asian/Pacific Islander O = Other R = Requested info. but refused to reply S = Sex Codes M = Male F = Female R = Requested info. but refused to reply D = Disposition Codes 01 = Hired 02 = Offered but declined 03 = Reached final consideration but not offered 04 = Less qualified - Did not reach final consideration 05 = Over qualified - Not considered 06 = Did not meet minimum qualifications 07 = Not interested or did not respond 08 = Withdrew application O = Origin - Internal/External I = GSU E = Applicant from off-campus P = Promotion                                                                                                    ADVANCE \d5(Use additional sheets if needed.)ADVANCE \u5 1) Was a Search Committee used? Yes No If yes, please list name, race & sex of all committee members on Page 2 (No. 4). Date %%%%%%%%%%%%%%%%%%%%%% Department Head's Signature %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Revised: June 2004 MAB Page 1 of 2 INSTRUCTIONS FOR COMPLETING APPLICANT DATA COMPLIANCE FORM 1. This form provides data on applicants for statistical reporting as required by Federal law and University policy. This form is completed by the department after the selection process is concluded. 2. Section I: Please provide the requested information on the person hired. Section II: The department or responsible official will provide the name, disposition and origin data for all applicants. The first name to appear in this section should be that of the person hired. 3. The five race/ethnic categories are: White (not of Hispanic Origin) - A person having origins in any of the original peoples of Europe, North Africa, or the Middle East. Black (not of Hispanic Origin) - A person having origins in any of the Black racial groups of Africa. American Indian or Alaskan Native - A person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation or community recognition. Hispanic - A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race. Asian or Pacific Islander - A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. The area includes, for example, China, Japan, India, Korea, the Philippine Islands, and Samoa. 4. Search Committee Members: Race/sex Search Committee Members: Race/Sex __ / _ __ _/___ / __ __ __ /___ +EFGQox % ^ ( * 6 z ~   " $ > J N Z b d 4ĹhCJaJhh5CJaJh,QCJH*OJQJ^JaJh,QCJH*aJh,Q5CJ\aJh,Q5>*CJ\aJhQ!CJaJh,Q>*CJaJjh,QUaJmHnHu h,Q5\h,QCJaJ7FHIp D 4VX [:$If :$If d7$If 2 p2 2VGW4FHRXlnrFMN[\%Q^9=PTgk~$%&*0jh,QUaJmHnHuh$=h,QCJaJh$=CJaJjh,QCJUaJh$=h,Q5CJ\aJh,Q5>*CJ\aJh,QCJH*OJQJ^JaJh,QCJaJh,Q5CJ\aJ:   569:=>ABEF dh$If :$If:$If d7$If [:$If&P_iv``6$ J`0}p@ P !$`'0*-/2p5@8}dh$If^}a$3 J`0}p@ P !$`'0*-/2p5@8v$If^vgd$=3$ J`0}p@ P !$`'0*-/2p5@8}$If^}a$ Io&56$ J`0}p@ P !$`'0*-/2p5@8}dh$If^}a$3$ J`0}p@ P !$`'0*-/2p5@8}$If^}a$ 56789:;<=>?@ABCDEF+ G`0p@ P !$`'0*-/2p5@8$If d]$IfFf0$ G`0p@ P !$`'0*-/2p5@8:$Ifa$FGHIJKLMNOPQRSTUVWXYZ[\]Ff+ G`0p@ P !$`'0*-/2p5@8$If d]$If]^_`abcdefghijklmnopqrstFf + G`0p@ P !$`'0*-/2p5@8$If d]$Iftuvwxyz{|}~FfI+ G`0p@ P !$`'0*-/2p5@8$If d]$IfFfv+ G`0p@ P !$`'0*-/2p5@8$If d]$IfFf+ G`0p@ P !$`'0*-/2p5@8$If d]$IfFf!+ G`0p@ P !$`'0*-/2p5@8$If d]$IfFf.,Ff&+ G`0p@ P !$`'0*-/2p5@8$If d]$IfFfc1+ G`0p@ P !$`'0*-/2p5@8$If d]$If     Ff; d]$IfFf6+ G`0p@ P !$`'0*-/2p5@8$If !"#$&'()*+Ff@ d]$If+ G`0p@ P !$`'0*-/2p5@8$If+,-./023456789:;<=>?@ABC+ G`0p@ P !$`'0*-/2p5@8$IfFf/F d]$If01=ARS^_`,Dz."螖wsgsh,Q5>*CJ\aJh,QhQ!CJaJhQ!CJH*OJQJ^JaJhRRCJaJhYCJaJhCJaJh,QCJH*OJQJ^JaJh,Q5CJ\aJh}CJaJh,Q>*CJaJjh,QCJUaJh$=h,QCJaJh,QCJaJjh,QUaJmHnHu&CDEFGHIJKLMNOPQRFfvK- G`0p@ P !$`'0*-/2p5@8:$If+ G`0p@ P !$`'0*-/2p5@8$If d]$IfR#$q[q$ P !$`'0*-/2a$#$ ;p@ P !$`'0*-/2a$ d:gd$ d:^a$gdz6)$ G`0p@ P !$`'0*-/2p5@8a$& G`0p@ P !$`'0*-/2p5@8 $;<.lqr'$ ;p@ P !$`'0*-/2^a$#$ ;p@ P !$`'0*-/2a$+$ ;p@ P !$`'0*-/20^`0a$<G -.3:lu>BCF~T.T6T@TKTvTyTTTTTTTTTUU UU9VVVVVVVWWWźh,Q5>*CJ\aJh,Q5CJ\aJhQ!h,QCJaJhQ!hYhYCJaJhYCJaJU h,Q>* h,Q6]h,Q h,Q5\DOPTTUUUU+$ ;p@ P !$`'0*-/20^`0a$#$ ;p@ P !$`'0*-/2a$'$ ;p@ P !$`'0*-/2`a$ / __ /___ / _ ___/___ 5. Applicant Data Forms should be submitted to the Equal Employment Opportunity Office immediately after a vacancy has been filled. It is particularly important to maintain all documents related to the selection and hiring process, including applications, rsums, reasons for the selection, etc. These records are maintained for at least three years and made available to the EEO Office upon request. 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