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EEOC Survey

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TVI would appreciate your help in providing the following information which will be used in the development of affirmative action reports and future hiring activity. Completion of this form is strictly VOLUNTARY and the form will be separated from your application immediately after processing by the Human Resources Office. This form will not be seen by the persons who interview and/or hire you. Employment decisions will not be based upon whether or not you provide this information.

Name *
Date of Birth
Job Number
Please check type of work desired (Definitions of EEO-6 Job Groups can be selected from the HR Menu page.) 10-Exec/Admin/Mgr 20-Faculty 30-Other professional 40-Technical and paraprofessional 50-Clerical/Secretarial 60-Skilled craft 70-Service/maintenance
Gender Female Male
Ethnicity (please check one of the following) American Indian Asian/Pacific Islander African American Hispanic Caucasian
Ethnicity Other
Check if any of the following is applicable Vietnam era vet Disabled vet Disabled individual
Age group (please check one of the following) Under 18 19-25 26-35 36-45 46-55 56-65 Over 65
Source Albuquerque Journal Chronicle of Higher Education Electronic Mail (E-mail) Internet Job Line Lobo New Mexico Department of Labor CNM Employee Referral Walk-in CNM Job Announcement CNM Student Placement Center Radio Television Word of Mouth Unknown
Source Other

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