Applicant Data Form
APPLICANT’S NAME
APPLICANT’S CITY
APPLICANT’S STATE
DATE
DEPARTMENT
POSITION APPLIED FOR
Thank you for your interest in employment at Tulane University. Tulane University does not discriminate against
any group or individual because of race, sex, color, religion, national/ethnic origin, age, citizenship, marital status,
sexual orientation, handicap or veteran status.
In order to comply with federal guidelines and to assess the effectiveness of our recruitment efforts, we ask that you
please complete and return this form to the Office of Institutional Equity.
Completion of this form is voluntary. If you do not wish to participate, check here
and return this form. The
information will be used for Equal Employment Opportunity reporting purposes only, not as a basis for any
employment decision.
ETHNICITY
Yes, Hispanic/Latino (If yes, do not check any boxes under the race category)
No, Not Hispanic/Latino (If no, check one box below)
RACE (please check one)
Black or African American
Asian
American Indian or Alaska Native
GENDER
Female
Male
White or Caucasian
Native Hawaiian or Other Pacific Islander
Two or More Races
Veteran (Please Complete Page 2)
yes
no
Category:
Affirmative Action Statement
Where underutilization in employment exists, the University is committed to taking affirmative action concerning
American Indians/Alaska Natives, Asians, Native Hawaiians and other Pacific Islanders, Blacks, Hispanics, women
and individuals age 40 and over. It is also committed to employ and advance in employment a qualified individual
with disabilities, qualified disabled veterans and Vietnam Era Veterans.
Disability Accommodations
Tulane University is committed to providing access and reasonable accommodation in its services, programs,
activities, education and employment for individuals with disabilities. To request a reasonable accommodation in
the application process, contact Disability Services at least ten days in advance at (504) 862-8433.
Completed form can be emailed to oie@tulane.edu, faxed to (504) 862-8220 or
mailed to the Office of Institutional Equity, 200 Broadway St., Suite 105A, New Orleans, LA 70118
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Veteran Voluntary Self-Identification Form
Under the regulations implementing the affirmative action provisions of VEVRAA issued by the Office of Federal
Contract Compliance Programs (OFCCP), a federal contractor is required to invite applicants and current
employees to inform the contractor whether he or she is a veteran belonging to one or more of the categories of
veterans covered under VEVRAA who wishes to benefit under the contractor’s affirmative action program (AAP)
for covered veterans.
In extending this invitation you are also advised that: (a) workers and applicants are under no obligation to respond,
but may do so in the future if they choose; (b) responses will remain confidential within the Office of Institutional
Equity; and (c) responses will be used only for the necessary information to include in our Veterans 100 Report.
Refusal to provide this information will have no bearing on your application and will not subject you to any adverse
treatment.
Please complete the information requested below. Thank you for your cooperation.
General Applicant Information
Name:
Date:
Position employed in or applied for:
Veteran Status Please check all that apply (see next page for definitions)
Special disabled veteran.
Veteran of the Vietnam era.
Other protected veteran (veteran who served on active duty in the U.S. military during a war or in a campaign or
expedition for which a campaign badge is awarded).
Recently separated veteran (veteran within 12 months from discharge or release from active duty).
I do not wish to self-identify
Completed form can be emailed to oie@tulane.edu , faxed to (504) 862-8220 or
mailed to the Office of Institutional Equity, 200 Broadway St., Suite 105A, New Orleans, LA 70118
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Veteran Status Definitions
Special disabled veteran means:
1. A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the
receipt of military retired pay would be entitled to compensation) under laws administered by the Department of
Veterans' Affairs for a disability (A) rated at 30 percent or more, or (B) rated at 10 or 20 percent in the case of a
veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap
2. A person who was discharged or released from active duty because of a service-connected disability.
Veteran of the Vietnam era means:
A person who:
1. Served on active duty in the U.S. military, ground, naval or air service for a period of more than 180 days and
who was discharged or released with other than a dishonorable discharge, if any part of such active duty was
performed:
(A) In the Republic of Vietnam between February 28, 1961, and May 7, 1975; Or
(B) Between August 5, 1964, and May 7, 1975, in all other cases.
2. Was discharged or released from active duty in the U.S. military, ground, naval or air service for a serviceconnected disability if any part of such active duty was performed:
(A) In the Republic of Vietnam between February 28, 1961, and May 7, 1975; Or
(B) Between August 5, 1964, and May 7, 1975, in any other location.
Other protected veteran means:
Veterans who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign
or expedition for which a campaign badge has been authorized.
Recently separated veteran means:
Any veteran who served on active duty in the U.S. military, ground, naval or air service during the one-year period
beginning on the date of such veteran’s discharge or release from active duty.
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