Equal Opportunity/ADA Office 10/13/2009

(VOLUNTARY) EQUAL OPPORTUNITY EMPLOYMENT DATA FORM University of North Carolina at Chapel Hill Equal Opportunity/ADA Office

To applicants for University of North Carolina at Chapel Hill EPA positions: UNC Chapel Hill is an Equal Opportunity Employer with a commitment to recruitment and retention of a diverse and inclusive campus community. Collection of the following information on sex and race/ethnicity data is to comply with Federal laws, executive orders, and applicable State laws and regulations. The information that you submit will remain confidential and will be used only by the UNC Chapel Hill Equal Opportunity Office for statistical purposes. Completion of this form is voluntary; failure to provide this information will not adversely affect your candidacy. Thank you for your interest in UNC Chapel Hill. Please complete this form and return it at your earliest convenience to:

Equal Opportunity/ADA Office OR Email: University of North Carolina at Chapel Hill [email protected] CB# 9160, 100 Pettigrew Hall Chapel Hill, NC 27599-9160

NAME: GENDER: Male Female

POSITION TITLE: RECRUITMENT ID# DATE ADVERTISED: DEPARTMENT:

ETHNICITY: Are you of Hispanic or Latino Origin? A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin regardless of race. Yes No

RACE: What is your race? Select one or more that Apply

White or Caucasian 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. Asian A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Bangladesh, Cambodia, China, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Sri Lanka, Thailand, and Vietnam. American Indian or Alaskan A person having origins in any of the original peoples of North and South America Native (including Central America) and who maintain tribal affiliation or community attachment. Native Hawaiian or Other A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or Pacific Islander other Pacific Islands.

VETERAN: Yes No

HOW DID YOU HEAR ABOUT THE POSITION? Letter Other (Please specify): Personal Referral (Please specify): Professional Journal (Please specify): University Website (Please specify):

Equal Opportunity/ADA Office 10/13/2009