OLYMPIC COLLEGE

INFORMATION FOR FEDERAL AND STATE REPORTING PURPOSES

OC is required by law to report the composition of its employment force to the government. Your voluntary cooperation is appreciated. Safeguards are used to prevent the discriminatory abuse of this information. It is available only to the person responsible for governmental reporting or for affirmative action reasons.

PERSONAL DATA Name:

Gender: Male Female

WHICH ETHNICITY DO YOU CONSIDER YOURSELF? Caucasian (800) Are you of Spanish/Hispanic origin? Black/African American (870) No, not Spanish/Hispanic (999) Native American List name of enrolled or principle tribe: ______Yes: Puerto Rican (727) Alaskan Native: Latino/Latina (720) Eskimo (935) Aleut (941) Other:______Cuban (709) Mexican, Mexican-American, Chicano (722) Asian or Pacific Islander: Other Hispanic/Spanish: ______Asian Indian (600) Chinese (605) Filipino (608) Guamanian (660) Hawaiian (653) Japanese (611) Korean (612) Samoan (655) Vietnamese (619)

WHERE DID YOU FIRST HEAR ABOUT THIS POSITION? OC Website Kitsap Sun State Board Website The Chronicle Classified Register Personal Reference Tacoma News Tribune OC Email Announcement Kitsap Newspaper Group (Bremerton Patriot, CK Reporter, PO Independent, etc) Other, please specify: ______

DISABILITY STATUS Do you have a physical, sensory or mental disability? No Yes, please check all that apply: Ambulatory/mobility (1) Visual (2) Hearing (3) Mental/psychological (4) Multiple Disabilities (5) Other (9) Please specify:

VETERAN STATUS Are you a Veteran? No

Yes: Vietnam Era Disabled Veteran (DV) Vietnam Era Veteran (VV) Special Disabled Veteran (DO) Other Veteran (OV) “Other Veterans” are those veterans who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized. See reverse side of this document to identify the campaigns or expeditions that meet this criterion. Dates of Service:

X:\Departments\HR\Onboarding\Onboarding Packet\AA Info Sheet.doc CAMPAIGNS AND EXPEDITIONS WHICH QUALIFY FOR VETERANS’ PREFERENCE A veteran’s DD 214 showing the award of any Armed Forces Expeditionary Medal is acceptable proof. The DD 214 does not have to show name of the theater or country of service for which that medal was awarded. Campaign or Expeditions with Inclusive Dates

Armed Forces Expeditionary Medal (AFEM) Berlin 08/14/61 to 06/01/63 Bosnia (Operations Joint Endeavor, Joint Guard, and Joint Forge) 11/20/95 to Present Cambodia 03/29/73 to 08/15/73 Cambodia Evacuation (Operation Eagle Pull) 04/11/75 to 04/13/75 Congo 07/14/60 to 09/01/62 and 11/23/64 to 11/27/64 Cuba 10/24/62 to 06/01/63 Dominican Republic 04/28/65 to 09/21/66 El Salvador 01/01/81 to 02/01/92 Grenada (Operation Urgent Fury) 10/23/83 to 11/21/83 Haiti (Operation Uphold Democracy) 09/16/94 to 03/31/95 Iraq (Operation Northern Watch) 01/01/97 to present Korea 10/01/66 to 06/30/74 Laos 04/19/61 to 10/07/62 Lebanon 07/01/58 to 11/01/58 and 06/01/83 to 12/01/87 Mayaquez Operation 05/15/75 Operations in the Libyan Area (Operation Eldorado Canyon) 04/12/86 to 04/17/86 Panama (Operation Just Cause) 12/20/89 to 01/31/90 Persian Gulf Operation (Operation Earnest Will) 07/24/87 to 08/01/90 Persian Gulf Operation (Operation Southern Watch) 12/01/95 to present Persian Gulf Operation (Operation Vigilant Sentinel) 12/01/95 to 02/01/97 Persian Gulf Operation (Operation Desert Thunder) 11/11/98 to 12/22/98 Persian Gulf Operation (Operation Desert Fox) 12/16/98 to 12/22/98 Persian Gulf Interception Operation 12/01/95 to present Quemoy and Matsu Islands 08/23/58 to 06/01/63 Somalia (Operation Restore Hope) 12/05/92 to 03/31/95 Taiwan Straits 08/23/58 to 01/01/59 Thailand 05/16/62 to 08/10/62 Vietnam Evacuation (Operation Frequent Wind) 04/29/75 to 04/30/75 Vietnam (Including Thailand) 07/01/58 to 07/03/65 Navy Expeditionary Medal and Marine Corps Medal for these Operations Cuba 01/03/61 to 10/23/62 Indian Ocean/Iran 11/21/79 to 10/20/81 Iranian/Yemen/Indian Ocean 12/08/78 to 06/06/79 Kosovo Campaign Medal (KCM) 1999 Lebanon 08/20/82 to 05/31/83 Liberia (Operation Sharp Edge) 08/05/90 to 02/21/91 Libyan Area 01/20/86 to 06/27/86 Panama 04/01/80 to 12/19/86 and 02/01/90 to 06/13/90 Persian Gulf 02/01/87 to 07/23/87 Rwanda (Operation Distant Runner) 04/07/94 to 04/18/94 Thailand 05/16/62 to 08/10/62 Other Campaign and Service Medals Qualifying for Preference Army Occupation of Austria 05/09/45 to 07/27/55 Army Occupation of Berlin 05/09/45 to 10/02/90 Army Occupation of Germany (exclusive of Berlin) 05/09/45 to 05/05/55 Army Occupation of Japan 09/03/45 to 04/27/52 Chinese Service Medal (Extended) 09/02/45 to 04/1/57 Korean Service 06/27/50 to 07/27/54 Navy Occupation of Austria 05/08/45 to 10/25/55 Navy Occupation of Trieste 05/08/45 to 10/25/54 Southwest Asia Service Medal (SWASM) (Operations Desert Shield and Desert Storm) 08/02/90 to 11/30/95 Units of the Sixth Fleet (Navy) 05/09/45 to 10/25/55 Vietnam Service Medal (VSM) 07/04/65 to 03/28/73

X:\Departments\HR\Onboarding\Onboarding Packet\AA Info Sheet.doc