UNIVERSITY OF COLORADO AT DENVER AND HEALTH SCIENCES CENTER

APPLICANT DATA FORM
 www.ucdhsc.edu/hr/dataform.htm

Mail to:  UCDHSC Human Resources
P.O. Box 173364, Mail Stop A005/CB130, Denver, CO 80217-3364
or email questions to: Human.Resources@uchsc.edu

In order to submit this form you must click on the "submit" button below

Providing this information is voluntary and will be kept confidential except as provided under governmental regulations.  The information provided will help us monitor our progress toward the goals of our affirmative action plan.  Questions regarding this form should be directed to Human Resources at 303-315-2700.

Last Name                           First Name        
Date (mm/dd/yy)

                        Male       Female                           U.S. Citizen:  Yes       No

Using the Federal Government definitions below, indicate the racial/ethnic group you consider yourself a member of:

American Indian or Alaskan (original peoples of North, South, Central America; maintains tribal affiliation or community attachment)
Asian (original peoples of Far East, Southeast Asia, Indian subcontinent)
Black, Non-Hispanic (origins in black racial groups in Africa)
Hispanic or Latino/a (people of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish cultures or origin regardless of race)
Native Hawaiian or Pacific Islander (original peoples of Hawaii, Guam, Samoa, other Pacific Islands)
White, Non-Hispanic (Europe, Middle East, North Africa)
Other (specify):  

        Position#                       Department/School

        Requisition#                  Position Applied For
 

This form will not be sent until you click on the "submit" button

    

Self-ID Rev. 9/05