Applicant Information and Confidentiality Request

Basic Information

First Name:

Last Name:

Position #:

Department:

Are you a U.S. citizen?
Yes
No
I do not wish to identify my citizenship status

Are you a veteran of the U.S. military?
Yes
No
I do not wish to reveal my veteran status

Are you disabled?
Yes
No
I do not wish to reveal my disability status

Anonymity Request

Wisconsin law requires UW-Eau Claire to provide, upon request, a list of all nominees and applicants for permanent positions. We are able to honor requests for anonymity in the initial phases of a search, but the law requires us to reveal the names of those who become finalists for positions regardless of their anonymity preference.

You may reveal my name as an applicant for this position
Please do not reveal my name (I acknowledge that if I become a finalist my name must be revealed upon request.)

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How did you learn of this position?

UW-Eau Claire Website
HigherEdJobs Website
Chronicle of Higher Education
Eau Claire Leader Telegram
From a UW-Eau Claire Employee
Other (please specify)

Self Identification Information

UW-Eau Claire requests your cooperation in providing information that will be used in accordance with Equal Employment Opportunity and Affirmative Action laws. Providing this information is voluntary. All information received will be kept confidential and separate from your employment application information.

Please select one:
Male Female Other
OR
I do not wish to identify my gender

Please select one:

Black, not of Hispanic Origin: persons having origins in any of the Black racial groups of Africa

Asian or Pacific Islander: persons having origins in any of the original peoples of the Far East. South East Asia, the Indian Subcontinent, and the Pacific Islands (i.e. China, Japan, Korea, Vietnam, Cambodia, the Philippine Islands, and Samoa)

American Indian or Alaskan Native: persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.

Hispanic: persons of Mexican, Puerto Rican, Cuban, Central or South America, or other Spanish culture or origin, regardless of race.

White, not of Hispanic origin: persons having origins in any of the original peoples of Europe, North Africa or Middle East

Other

I do not wish to identify my race

Provide any additional information:
(Optional. Please limit to 1,000 characters or less)