Equal Employment Opportunity Data Form

Equal Employment Opportunity Data Form

  • Equal Employment Opportunity Data Form

  • IMPORTANT: Siena College is an equal opportunity employer and surveys all job applicants in accordance with the U.S. Department of Labor's affirmative action requirements. Therefore, Siena College requests that you complete this personal data form. Information will be detached and kept separate from your application of employment. Any information that you choose to provide will be treated as personal and confidential. Your cooperation is key to maintaining an effective equal opportunity program at the College and is greatly appreciated.

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    Note that if you have identified yourself as Hispanic or Latino/Latina, you may, but are not required to, select an additional category.

    White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
    Black or African-American - A person having origins in any of the black racial groups of Africa.
    Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
    Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
    American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

  • Veteran Classification and Self-Identification
    This employer is a Government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:
    • A “disabled veteran” is one of the following:
      • A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
      • A person who was discharged or released from active duty because of a service-connected disability.
    • A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service.
    • An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
    • An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.


    Protected veterans may have additional rights under USERRA – the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor’s Veterans Employment and Training Service (VETS), toll free, at 1-866-4-USA-DOL.

    If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.
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  • Voluntary Self-Identification of Disability

    Why are you being asked to complete this form?

    Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

    If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

    How do I know if I have a disability?

    You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

    Disabilities include, but are not limited to:

    • Blindness
    • Deafness
    • Cancer
    • Diabetes
    • Epilepsy
    • Autism
    • Cerebral palsy
    • HIV/AIDS
    • Schizophrenia
    • Muscular dystrophy
    • Bipolar disorder
    • Major depression
    • Multiple sclerosis (MS)
    • Missing limbs or partially missing limbs
    • Post-traumatic stress disorder (PTSD)
    • Obsessive compulsive disorder
    • Impairments requiring the use of a wheelchair
    • Intellectual disability (previously called mental retardation)
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  • Reasonable Accommodation Notice

    Form CC-305
    OMB Control Number 1250-0005
    Expires 1/31/2017

    Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities.    Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

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       [1] Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.
     
    PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

    Please Contact Sherrill Brown, Assistant Director of Human Resources, in the Office of Human Resources at 518-786-5063 or at sbrown@siena.edu if you require a reasonable accommodation.

    As a student with a disability, you may be entitled to academic accommodations as well. For more information please contact the Director of the Services for Students with Disabilities Office at 518-783-4239.
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