Applicant Survey
Confidential Information
For research purposes and to assess the effectiveness of Cabrillo’s outreach and recruitment efforts, we request that you complete this
voluntary survey and submit it with your application. This information will be kept separate from all hiring documents and is
maintained on a confidential basis. COMPLETING THIS SURVEY IS STRICTLY VOLUNTARY. The statistics gathered from this survey help
to assess outreach and recruitment efforts. The Search Committee will not have access to this information, and no employment
determination will be based on it. Thank you for your cooperation.
Name
(Last)
(First)
(Middle)
Position Title/Number
Position Status: (please circle one)
Full-time
Part-time
Temporary
I prefer not to complete this form.
Ethnic Categories: (check only one category)
African American: (includes all persons having origins in any of the black racial groups of Africa.)
Asian or Pacific Islander (includes all persons having origins in any of the original peoples of the Far East, Southeast Asia or the
Pacific Islands.) Please circle one of the following categories: Chinese, Japanese, Korean, Vietnamese, Asian Indian, Hawaiian,
Guamanian, Samoan, Laotian, Cambodian, other Asian.
Filipino (includes persons having origins in any of the original people of the Philippine Islands.)
Hispanic American: (includes all persons of Chicano, Mexican, Puerto Rican, Cuban, Central or South American, or other
Spanish culture or origin regardless of race.)
Native American Indian or Alaskan Native (includes all persons having origins in any of the original peoples of North
America and who maintain cultural identifications through tribal affiliation or community recognition.)
White: (include all persons having origins in any of the original peoples of Europe, North Africa, the Middle East, and not
of Hispanic Origin.)
Other
Personal Information:
Male
Female
Date of Birth: _________________________________________________________________________________________________________
Disabled:
None
Yes Identify:
How did you learn about this position?
From:
Cabrillo College Employee
Cabrillo Interest Card
Friend or Relative
Google Search
Internet Site
Job Fair (List by location)
Newspaper (List by name)
Personnel Office (List by name)
Professional Organization (List by name)
University Placement Office (List by name)
Other (Describe)
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