Office of the President

Office of the President

Susquehanna University

Affirmative Action: Applicant Survey Form

The University is committed to equal opportunity employment, nondiscrimination, and affirmative action. The information is voluntary and will be used for statistical purposes to assist the University in meeting its affirmative action and equal opportunity employment objectives.

Name (optional):

Sex: male female

Position applied for:

Department advertising position:

Please check one of the following:

American Indian or Alaskan Native - Any person having origin in any of the original peoples of North America and maintaining cultural identification through tribal affiliation or community recognition.

Black (not of Hispanic origin) - Any person having origin in any of the black racial groups.

White ( not of Hispanic origin) - Any person having origin in any of the peoples of Europe, North Africa, or the Middle East.

Asian or Pacific Islander - Any person having origin in any of the original peoples of the Far East, Southeast Asia, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Phillipine Islands, Samoa, or the Indian Subcontinent.

Hispanic - Any person of Mexican, Puerto Rican, Cuban, or South American or other Spanish culture or origin regardless of race.

If there is any type of position for which you should not be considered, or duties you cannot perform because of a physical or mental handicap, please describe: