Faculty Applicant Survey Form for Academic Year 2011-12

California State University San Marcos (CSUSM) considers qualified applicants for employment without regard to race, color, religion, national origin, ancestry, physical or mental disability, medical condition, genetic information, marital status, sex (including gender identity), age (over 40), sexual orientation, covered veteran status, or any other protected status.

CSUSM is interested in reaching the broadest possible group of qualified applicants. This form has been developed to assist us in monitoring the effectiveness of our recruitment efforts, and in collecting data that is required for compliance with State, Federal and University reporting requirements. This form, and any data submitted on the form, will be kept separate from your application and resume and will not be accessible by anyone involved with making recommendations or decisions regarding selection or hiring for this job. While your reply will be most helpful to us in reporting accurate data, completing this form is entirely voluntary.

1. Position:

2. College:

3. Department:

4. Date of application:

5. Zip code:

6. Name:

First Name

Last Name

MI

7. Gender:

Male
Female

8. Are you Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)

Yes
No

9. Regardless of your answer to the previous question, you may select one or more of the following categories that apply to you.
Please note: If you select Asian or Native Hawaiian/Other Pacific Islander, additional selections will be made available.

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

Asian

Asian Indian
Cambodian
Chinese
Filipino

Japanese
Korean
Laotian
Vietnamese

Native Hawaiian or Other Pacific Islander

Guamanian
Hawaiian
Samoan
Other Native Hawaiian or Other Pacific Islander

10. What prompted you to apply to CSUSM?

11. Name of Profession Journal with print ad.

12. Name of Profession Journal with online ad.

13. Name of personal contact:

14. Other: