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Affirmative Action Applicant Data Form

How to Use This Online Form

  1. Complete the web form below.
  2. Review the form and make sure that all required questions (indicated by *) have been answered.
  3. Click on Submit Form button to submit application electronically, or
  4. Print the form and send the completed form to:
    OFFICE OF DIVERSITY INITIATIVES AND AFFIRMATIVE ACTION
    University of Maryland University College
    3501 University Boulevard East Adelphi, MD 20783-8003

University of Maryland University College is committed to providing equal employment opportunities free of discrimination on the basis of race, religion, color, sex, national origin, age, disability, sexual orientation or status as a disabled or Vietnam era veteran. As part of our Affirmative Action Program, UMUC seeks to collect demographic information from our job applicants. Provision of this information is voluntary and only will be used to monitor the success of UMUC's recruitment efforts. The information you provide will be kept confidential by UMUC's Office of Diversity Initiatives and will not be used in any way to evaluate your qualifications for employment

This information is voluntary and will be used to monitor the success of our recruitment efforts. It is kept confidential and will not be used in any way to evaluate your qualifications for employment.

Additional Information: Please see the diversity information page for listing of laws and regulations, and the definitions of the five race/ethnic, veterans’ preference, and disabled categories listed below.

* indicates required information

 *Control Number:  
(list of jobs and control numbers ) 
Applicant Name:
     
(Last Name)   (First Name)

    (M.I.)

*Position Applied For:

*How did you learn of this vacancy?

Please check applicable categories in A through D below.

  1. * Gender: Male Female

  2. * Race/Ethnicity (select one):

    3. White (Non-Hispanic) Hispanic American Indian/Alaskan Native
    Black (Non-Hispanic) Asian or Pacific Islander
    Other:

  3. * Veterans' Status:

    4. Veteran Disabled Veteran Vietnam Era Veteran Not a Veteran

  4. * Disability Status: Yes No
   

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3501 University Blvd. East
Adelphi, Maryland 20783 USA

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